Transarterial Chemoembolization of Hepatocellular Carcinoma: Propensity Score Matching Study Comparing Survival and Complications in Patients with Nonalcoholic Steatohepatitis Versus Other Causes Cirrhosis

Purpose To evaluate the oncologic outcomes and complication profile in nonalcoholic steatohepatitis (NASH)-induced cirrhosis leading to hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Materials and Methods Two hundred and twenty patients who underwent treatment of 353 HCCs were retrospectively reviewed, including 30 NASH patients who received TACE for 46 HCCs. Patient charts were evaluated for time to progression (TTP), complications and overall survival (OS). The group was split into NASH and non-NASH cohorts for comparison and additional analyses were done using propensity score matching (PSM). Results Patients in the NASH cohort presented with significantly larger lesions (4.9 +/- 5.8 cm vs 3.1 +/- 2.4 cm, p = 0.05). There was no significant difference in TTP overall [Median NASH 396 days (95% CI 308-526 days) vs non-NASH cohort 307 days (95% CI 272-364), p = 0.25) or after PSM [259 days non-NASH (95% CI 215-490) vs 396 days NASH (95% CI (349-not reached), p = 0.43]. There was a non-significant increased OS in the non-NASH [median 1078 days (95% CI 668-1594)] as compared to the NASH cohort [median 706 days (95% CI 314-not reached)] (p = 0.08) which decreased following PSM [853 days (95% CI 526-1511) non-NASH vs 706 days (95% CI 314-not reached) NASH, p = 0.48]. The number of complications did not differ significantly between the two groups (p = 0.23). Conclusion The oncologic outcomes and complication profile of TACE for HCC induced by NASH cirrhosis appear to be similar to that of other etiologies of cirrhosis. NASH patients presented with larger tumors emphasizing the need for early surveillance.