By Richard Dargan
Longer intervals between the first two sessions of transarterial chemoembolization (TACE) result in better overall survival than shorter ones in patients with liver cancer, according to research presented Sunday.
“This improved survival may reflect differences in tumor characteristics like size and microvascularization,” explained study lead author Uuganbayar Batbayar, MD, MBA, of Second State Central Hospital in Ulaanbaatar, Mongolia.
Hepatocellular carcinoma (HCC) is responsible for 700,000 deaths annually, making it the third most common cause of cancer-related death worldwide. Curative treatments include surgery, radiofrequency ablation (RFA) and TACE, yet several studies have shown that local recurrence often occurs after TACE.
To address this issue, Dr. Batbayar and colleagues set out to determine predictive risk factors of local HCC recurrence after TACE and compare the efficacy and safety of long- versus short-interval treatments.
They looked at 500 patients with HCC who underwent TACE at their institution between 2021 and 2025. The patients were classified according to the Barcelona Clinic Liver Cancer staging system, a widely used framework for assessing HCC and guiding treatment decisions, as Stage C. This indicated an advanced stage characterized by symptomatic tumors and/or an invasive tumor pattern.
The median TACE interval was 7.5 months. Of the patients studied, 58.6% had a short interval of less than 7.5 months between treatments, while 41.4% had a long interval of 7.5 months or more.
“Patients requiring less frequent TACE sessions likely had more indolent tumors and better-preserved liver function, allowing sustained disease control,” Dr. Batbayar said. “Conversely, those with shorter TACE intervals may have had more aggressive disease, necessitating repeated interventions and resulting in poorer survival outcomes.”
“Larger tumors are associated with higher malignant potential and increased microvascular invasion, which raises the risk of recurrence and often leads to shorter intervals between TACE sessions,” Dr. Batbayar added.
Analysis showed that alcohol consumption and elevated serum levels of alpha fetoprotein were associated with greater risk of cancer recurrence and poorer survival rates. Uptake of the contrast medium lipiodol in the tumor also had a significant impact on post-TACE recurrence. Lipiodol uptake is an important post-procedural imaging biomarker that reflects the extent of embolization and tumor necrosis.
“Our findings underscore the prognostic value of incorporating post-TACE imaging parameters and procedural timing into clinical decision-making. By evaluating lipiodol uptake patterns and TACE intervals, clinicians can more accurately stratify patients by recurrence risk, optimize retreatment schedules and tailor therapeutic strategies, ultimately improving both survival and quality of life for individuals with hepatocellular carcinoma.”
Uuganbayar Batbayar, MD, MBA
The researchers plan to validate the findings in larger, multicenter cohorts and incorporate quantitative imaging analytics, including radiomics.
“Our goal is to develop a predictive framework that combines imaging, clinical and procedural factors, including TACE intervals, to guide precision-based treatment planning for patients undergoing TACE,” Dr. Batbayar said. “We also want to evaluate the clinical outcomes and assess the impact on quality of life in patients receiving combined TACE and RFA treatment.”
Erdenebulgan Batmunkh, MD, PhD, head of the Department of Interventional Radiology and Diagnostic Imaging Center at Second State Central Hospital, supervised the study.
Access the presentation, “Predictive Factors of Local Recurrence and Overall Survival in Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization,” (S1-STCE1-1) on demand at RSNA.org/MeetingCentral.
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The RSNA 2025 Daily Bulletin is the official publication of the 110th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Published online Sunday, November 30 — Thursday, December 4.
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