Elisa Pinto, Filippo Pelizzaro, Vittorio Simeon, Laura Bucci, Martina Gambato, Alessandro Vitale, Angelo Sangiovanni, Giuseppe Cabibbo, Giorgia Ghittoni, Gianluca Svegliati‐Baroni, Sara Boninsegna, Franco Trevisani, Francesco Giuseppe Foschi, Bernardo Stefanini, C. Saitta, Francesco Azzaroli, F. Marra, G. Vidili, Andrea Mega, Giacomo Zaccherini, Maurizia Rossana Brunetto, Sara Grasselli, Francesca Romana Ponziani, Filomena Morisco, Rodolfo Sacco, Donatella Magalotti, Gerardo Nardone, Mariacristina Di Marco, Andrea Martini, David Sacerdoti, Fabio Farinati, E. Giannini, Francesco Paolo Russo, the ITA.LI.CA study group
BACKGROUND: In patients with hepatocellular carcinoma (HCC), extrahepatic progression (EHP) has a known dismal meaning. We evaluated the incidence and risk factors of EHP in HCC patients treated with transarterial chemoembolization (TACE), and the predictive role of tumour burden. METHODS: From the ITA.LI.CA database, 890 HCC patients undergoing first-line TACE were included. Tumour burden score (TBS) was calculated and, after identification of the best cut-point value, incidence and predictors of EHP were compared between TBS-low and TBS-high groups. Independent predictors of EHP at the first progression episode or at any time during follow-up were identified through multivariable Cox analysis. RESULTS: After TACE, 7.2% of patients experienced EHP at the first progression episode, while the overall EHP rate during the follow-up was 26.1%. The best cut-point for TBS was 3.66. TBS-high group (> 3.66) showed a significantly higher proportion of EHP both at first progression (10.4% vs. 3.6%; p < 0.001) and overall (32.6% vs. 18.7%; p < 0.001) compared to the TBS-low group. Moreover, TBS-high patients had shorter progression-free survival and overall survival. TBS-high and AFP levels emerged as independent predictors of EHP at the first progression episode and during the follow-up, and their combined evaluation accurately stratified patients for their risk of EHP. CONCLUSION: Extrahepatic dissemination is infrequent in HCC patients treated with TACE. TBS is easily calculable and helps in identifying patients at higher risk of metastasis development.