Comparison of LI-RADS Scores Before and After Transarterial Chemoembolization (TACE) in Hepatocellular Carcinoma Patients
Main Article Content
Taufik Rahman*
Hartono Yudi Sarastika
Widiana Ferriastuti
Hepatocellular carcinoma (HCC) is the most frequent primary liver malignancy, notorious for its elevated mortality. In intermediate-stage HCC where surgical resection is contraindicated, transarterial chemoembolization (TACE) is the primary treatment modality. Accurate evaluation of therapeutic response is essential to guide ongoing patient management. The Liver Imaging Reporting and Data System (LI-RADS), particularly its Treatment Response (LI-RADS TR) criteria, provides a validated radiographic method for assessing lesions before and after locoregional interventions. This study compared LI-RADS scores before and after TACE in patients at Dr. Soetomo Regional General Hospital, Surabaya. A retrospective observational design was employed, involving 37 HCC patients who underwent TACE and abdominal CT between January 2024 and July 2025. Statistical analysis used the paired t-test or Wilcoxon test (p < 0.05). The majority of patients were male (67.6%) with a mean age of 55.3 years. Before TACE, the most common categories were LR-5 (51.4%) and LR-4 (48.6%). Following TACE, 78.4% of tumors were classified as viable and 21.6% as non-viable by LI-RADS TR. No significant difference in tumor size was observed, but tumor-to-liver ratio was significantly reduced (p < 0.001). No significant association was identified between pre-TACE LI-RADS characteristics and post-TACE LI-RADS TR categories, except for the pre-treatment tumor-to-liver ratio. TACE significantly reduced the tumor-to-liver ratio; however, most lesions remained viable by LI-RADS TR. LI-RADS and LI-RADS TR are important tools for evaluating treatment response and guiding further management in HCC patients.
Akbulut, S., Küçükakçalı, Z., & Çolak, C. (2022). Machine Learning-Based Classification of HBV and HCV-Related Hepatocellular Carcinoma Using Genomic Biomarkers. Journal of Istanbul Faculty of Medicine / İstanbul Tıp Fakültesi Dergisi, 85(4), 532-540. https://doi.org/10.26650/IUITFD.1130442
Albrecht, K. C., Aschenbach, R., Diamantis, I., Eckardt, N., & Teichgräber, U. (2021). Response rate and safety in patients with hepatocellular carcinoma treated with transarterial chemoembolization using 40-µm doxorubicin-eluting microspheres. Journal of Cancer Research and Clinical Oncology, 147(1), 23-32. https://doi.org/10.1007/s00432-020-03370-z
Alhasan, A., Cerny, M., Olivié, D., Billiard, J.-S., Bergeron, C., Brown, K., Bodson-Clermont, P., Castel, H., Turcotte, S., Perreault, P., & Tang, A. (2019). LI-RADS for CT diagnosis of hepatocellular carcinoma: performance of major and ancillary features. Abdominal Radiology, 44(2), 517-528. https://doi.org/10.1007/s00261-018-1762-2
Amalia, A., Latief, N., Murtala, B., Zainuddin, A. A., & Daud, N. A. (2020). Factors affecting tumor response to transarterial chemoembolization (TACE) therapy in patient with hepatocellular carcinoma (HCC). Journal of Thee Medical Sciences (Berkala Ilmu Kedokteran), 52(2), 144-152. https://doi.org/10.19106/JMedSci005202202006
Asafo-Agyei, K. O., & Samant, H. (2023). Hepatocellular Carcinoma. StatPearls Publishing.
Asayama, Y., Nishie, A., Ishigami, K., Ushijima, Y., Takayama, Y., Okamoto, D., Fujita, N., Morita, K., & Honda, H. (2016). Hemodynamic changes under balloon occlusion of hepatic artery: predictor of the short-term therapeutic effect of balloon-occluded transcatheter arterial chemolipiodolization using miriplatin for hepatocellular carcinoma. SpringerPlus, 5(1), 157. https://doi.org/10.1186/s40064-016-1880-7
Awadh, A. A., Alharthi, A. A., Alghamdi, B. A., Alghamdi, S. T., Baqays, M. K., Binrabaa, I. S., & Malli, I. A. (2024). Coinfection of Hepatitis B and C Viruses and Risk of Hepatocellular Carcinoma: Systematic Review and Meta-analysis. Journal of Global Infectious Diseases, 16(4), 127-134. https://doi.org/10.4103/jgid.jgid_211_23
Bannangkoon, K., Hongsakul, K., & Tubtawee, T. (2021). Impact of Cone-Beam Computed Tomography with Automated Feeder Detection Software on the Survival Outcome of Patients with Hepatocellular Carcinoma During Chemoembolization. https://doi.org/10.21203/rs.3.rs-953852/v1
Bartnik, K., Podgórska, J., Rosiak, G., Korzeniowski, K., & Rowiński, O. (2022). Inter-observer agreement using the LI-RADS version 2018 CT treatment response algorithm in patients with hepatocellular carcinoma treated with conventional transarterial chemoembolization. Abdominal Radiology, 47(1), 115-122. https://doi.org/10.1007/s00261-021-03272-9
Bayle, M., Clerc-Urmès, I., Ayav, A., Bronowicki, J.-P., Petit, I., Orry, X., & Laurent, V. (2019). Computed tomographic perfusion with 160-mm coverage: comparative analysis of hepatocellular carcinoma treated by two transarterial chemoembolization courses relative to magnetic resonance imaging findings. Abdominal Radiology, 44(1), 85-94. https://doi.org/10.1007/s00261-018-1714-x
Behnagh, A. K., Rezaei, N., Jahannia, M., Noorimotlagh, Z., & Kabir, A. (2017). New modalities of treatment for hepatocellular carcinoma. Journal of Contemporary Medical Sciences, 3(11), 239-252. https://doi.org/10.22317/jcms.09201701
Brozzetti, S., Bini, S., Luca Chiarella, L., Fazzi, K., Di Martino, M., & Bezzi, M. (2018). HCC in Elderly Patients. Curative Intraoperative Strategies and Management in Recurrences. In Liver Cancer. IntechOpen. https://doi.org/10.5772/intechopen.79748
Cerban, R., Ester, C., Iacob, S., Paslaru, L., Dumitru, R., Grasu, M., Constantin, G., Popescu, I., & Gheorghe, L. (2018). Evaluation of Tumor Response Using Alpha-fetoprotein and Des-gamma-carboxy Prothrombin in Hepatocellular Carcinoma Patients Who Underwent Transarterial Chemoembolization. Chirurgia, 113(4), 524. https://doi.org/10.21614/chirurgia.113.4.524
Chang, K.-H., Hwang, Z.-A., Chang, P.-Y., Lin, H.-H., Shih, Y.-L., Chang, W.-C., Huang, G.-S., & Hsu, H.-H. (2019). Predictive imaging for tumor response to drug-eluting microsphere transarterial chemoembolization in patients with BCLC-C advanced hepatocellular carcinoma. Scientific Reports, 9(1), 20032. https://doi.org/10.1038/s41598-019-56545-1
Chang, Y., Jeong, S. W., Young Jang, J., & Jae Kim, Y. (2020). Recent Updates of Transarterial Chemoembolilzation in Hepatocellular Carcinoma. International Journal of Molecular Sciences, 21(21), 8165. https://doi.org/10.3390/ijms21218165
Chen, J., Lai, L., Lin, Q., Huang, W., Cai, M., Zhu, K., & Huang, M. (2017). Hepatic resection after transarterial chemoembolization increases overall survival in large/multifocal hepatocellular carcinoma: a retrospective cohort study. Oncotarget, 8(1), 408-417. https://doi.org/10.18632/oncotarget.13427
Chen, Y., Shi, K., Li, Z., Wang, H., Liu, N., Zhan, P., Liu, X., Shang, B., Hou, P., Gao, J., & Lyu, P. (2023). Survival prediction of hepatocellular carcinoma by measuring the extracellular volume fraction with single-phase contrast-enhanced dual-energy CT imaging. Frontiers in Oncology, 13. https://doi.org/10.3389/fonc.2023.1199426
Chiu, S.-H., Chang, P.-Y., Shih, Y.-L., Huang, W.-Y., Ko, K.-H., Chang, W.-C., & Huang, G.-S. (2020). Efficacy and Safety of Supplemental Transarterial Chemoembolization Through Extrahepatic Collateral Arteries with Drug-eluting Beads: Treatment for Unresectable Hepatocellular Carcinoma. Drug Design, Development and Therapy, 14, 5029-5041. https://doi.org/10.2147/DDDT.S266470
Cho, E., Cho, H. A., Jun, C. H., Kim, H. J., Cho, S. B., & Choi, S. K. (2019). A Review of Hepatocellular Carcinoma in Elderly Patients Focused on Management and Outcomes. In Vivo, 33(5), 1411-1420. https://doi.org/10.21873/invivo.11618
Cho, Y., Choi, J. W., Kwon, H., Kim, K. Y., Lee, B. C., Chu, H. H., Lee, D. H., Lee, H. A., Kim, G. M., Oh, J. S., Hyun, D., Lee, I. J., & Rhim, H. (2023). Transarterial chemoembolization for hepatocellular carcinoma: 2023 Expert consensus-based practical recommendations of the Korean Liver Cancer Association. Clinical and Molecular Hepatology, 29(3), 521-541. https://doi.org/10.3350/cmh.2023.0202
Choi, J., Lee, D., Shim, J. H., Kim, K. M., Lim, Y.-S., Lee, Y. S., & Lee, H. C. (2020). Evaluation of transarterial chemoembolization refractoriness in patients with hepatocellular carcinoma. PLOS ONE, 15(3), e0229696. https://doi.org/10.1371/journal.pone.0229696
Chuang, W.-Y., Shen, P.-C., Chiu, S.-H., Huang, W.-Y., Chang, W.-C., Lin, C.-S., & Lo, C.-H. (2025). Lenvatinib in combination with radiotherapy versus lenvatinib with transarterial chemoembolization for advanced hepatocellular carcinoma. BMC Cancer, 25(1), 1449. https://doi.org/10.1186/s12885-025-14931-1
Chui, A. M. N., Yau, T. C. C., & Cheung, T. T. (2020). An overview in management of hepatocellular carcinoma in Hong Kong using the Hong Kong Liver Cancer (HKLC) staging system. Global Health & Medicine, 2(5), 312-318. https://doi.org/10.35772/ghm.2020.01062
de Baere, T., Ronot, M., Chung, J. W., Golfieri, R., Kloeckner, R., Park, J.-W., Gebauer, B., Kibriya, N., Ananthakrishnan, G., & Miyayama, S. (2022). Initiative on Superselective Conventional Transarterial Chemoembolization Results (INSPIRE). CardioVascular and Interventional Radiology, 45(10), 1430-1440. https://doi.org/10.1007/s00270-022-03233-9
Ding, Y.-J., Chang, T.-S., Shen, C.-H., Kuo, L.-M., Hsu, S.-L., Chen, Y.-H., Huang, H.-L., & Lu, S.-N. (2023). Survival Benefit of Sequential Curative Treatment for TACE Suitable BCLC Stage B HCC Patients. https://doi.org/10.21203/rs.3.rs-3472960/v1
Dioguardi Burgio, M., Sartoris, R., Libotean, C., Zappa, M., Sibert, A., Vilgrain, V., & Ronot, M. (2019). Lipiodol retention pattern after TACE for HCC is a predictor for local progression in lesions with complete response. Cancer Imaging, 19(1), 75. https://doi.org/10.1186/s40644-019-0260-2
Dorochowicz, M., Krzemienowska-Cebulla, A., Matus, I., & Senat, H. (2023). Advances and Challenges in Hepatocellular Carcinoma: A Comprehensive Review. Journal of Education, Health and Sport, 49(1), 27-43. https://doi.org/10.12775/JEHS.2023.49.01.002
El-Assaly, H., Abdelwahab, E., El Sebai, S. M., & Grace, M. N. (2023). Can triphasic hepatic multislice CT validate the LI-RADS treatment response algorithm after trans-catheter arterial chemoembolization treatment of hepatocellular carcinoma? Egyptian Journal of Radiology and Nuclear Medicine, 54(1), 3. https://doi.org/10.1186/s43055-022-00939-1
Elkadeem, M. (2018). Transarterial chemoembolization in patients with hepatocellular carcinoma: study of different outcomes and their predictive factors. Liver Research, Disorders & Therapy, 4(4), 157-164. https://doi.org/10.15406/jlrdt.2018.04.00120
Eltabbakh, M., Abdella, H. M., Askar, S., Abuhashima, M. A., & Shaker, M. K. (2021). Risk stratification of patients with hepatocellular carcinoma undergoing trans arterial chemoembolization using an alpha-fetoprotein model. Egyptian Liver Journal, 11(1), 87. https://doi.org/10.1186/s43066-021-00155-y
Federico, P., Giunta, E. F., Pappalardo, A., Tufo, A., Marte, G., Attademo, L., Fabbrocini, A., Petrillo, A., & Daniele, B. (2021). How to Treat Hepatocellular Carcinoma in Elderly Patients. Pharmaceuticals, 14(3), 233. https://doi.org/10.3390/ph14030233
Fernandes, P. H. dos S., Almeida, Y. N. R. de, Moreira, A. J. da S., Nascimento, M. T. A., Solano, A. C. dos A., Lopes, S. T. L., Sousa, C. Q. D. de, Nascimento, C. S. A. do, Silva, J. H. S., & Silva, E. da. (2022). Atenção multiprofissional a paciente portador de carcinoma hepatocelular: um relato de experiência. Research, Society and Development, 11(10), e67111032370. https://doi.org/10.33448/rsd-v11i10.32370
Fernández-Ruiz, M., Guerra-Vales, J. M., Llenas-García, J., & Colina-Ruizdelgado, F. (2008). Hepatocellular carcinoma in the elderly: clinical characteristics, survival analysis, and prognostic indicators in a cohort of Spanish patients older than 75 years. Revista Española de Enfermedades Digestivas, 100(10), 625-631. https://doi.org/10.4321/S1130-01082008001000005
Fite, E. L., & Makary, M. S. (2024). Transarterial Chemoembolization Treatment Paradigms for Hepatocellular Carcinoma. Cancers, 16(13), 2430. https://doi.org/10.3390/cancers16132430
Goh, M. J., Sinn, D. H., Kim, J. M., Lee, M. W., Hyun, D. H., Yu, J. Il, Hong, J. Y., & Choi, M. S. (2023). Clinical practice guideline and real-life practice in hepatocellular carcinoma: A Korean perspective. Clinical and Molecular Hepatology, 29(2), 197-205. https://doi.org/10.3350/cmh.2022.0404
Greten, T., Malek, N., Schmidt, S., Arends, J., Bartenstein, P., Bechstein, W., Bernatik, T., Bitzer, M., Chavan, A., Dollinger, M., Domagk, D., Drognitz, O., Düx, M., Farkas, S., Folprecht, G., Galle, P., Geißler, M., Gerken, G., Habermehl, D., … Zech, C. (2013). Diagnostik und Therapie des hepatozellulären Karzinoms. Zeitschrift Für Gastroenterologie, 51(11), 1269-1326. https://doi.org/10.1055/s-0033-1355841
Gruber-Rouh, T., Naguib, N., Eichler, K., Nour-Eldin, N., Beeres, M., & Vogl, T. (2018, April). Transarterial Chemoembolization (TACE) using Mitomycin and Lipiodol with or without Degradable Starch Microspheres for Hepatocellular Carcinoma: comparative study. https://doi.org/10.1055/s-0038-1641318
Guo, C., Du, W., Chen, Y., Xiao, W., Sun, K., Shen, Y., Zhang, M., Wu, J., Gao, S., Yu, J., Que, R., Xue, X., Bai, X., & Liang, T. (2024). Survival Analysis of TACE Monotherapy vs. Combination Therapy in BCLC B and C Stage Hepatocellular Carcinoma: A Retrospective Cohort Study. https://doi.org/10.21203/rs.3.rs-5011990/v1
Guo, H., Wu, T., Lu, Q., Dong, J., Ren, Y.-F., Nan, K.-J., Lv, Y., & Zhang, X.-F. (2017). Hepatocellular carcinoma in elderly: Clinical characteristics, treatments and outcomes compared with younger adults. PLOS ONE, 12(9), e0184160. https://doi.org/10.1371/journal.pone.0184160
Hasdemir, D. B., Dávila, L. A., Schweitzer, N., Meyer, B. C., Koch, A., Vogel, A., Wacker, F., & Rodt, T. (2017). Evaluation of CT vascularization patterns for survival prognosis in patients with hepatocellular carcinoma treated by conventional TACE. Diagnostic and Interventional Radiology, 23(3), 217-222. https://doi.org/10.5152/dir.2016.16006
Hui, F., Xu, C., Xu, X., Chen, J., Geng, H., Yang, C., & Zhang, Y. (2022). What Is the Most Suitable Agent Combined With Apatinib for Transarterial Chemoembolization Treatment in Advanced Hepatocellular Carcinoma Patients? A Systematic Review and Network Meta-analysis. Frontiers in Oncology, 12, 887332. https://doi.org/10.3389/fonc.2022.887332
Janevska, D., Chaloska-Ivanova, V., & Janevski, V. (2015). Hepatocellular Carcinoma: Risk Factors, Diagnosis and Treatment. Open Access Macedonian Journal of Medical Sciences, 3(4), 732-736. https://doi.org/10.3889/oamjms.2015.111
Ji, J., Yang, W., Shi, H.-B., Liu, S., & Zhou, W.-Z. (2022). Transcatheter arterial chemoembolization alone versus combined with microwave ablation for recurrent small hepatocellular carcinoma after resection: a retrospective comparative study. BMC Gastroenterology, 22(1), 321. https://doi.org/10.1186/s12876-022-02387-7
Kanneganti, M., Al-Hasan, M., Bourque, S., Deodhar, S., Yang, J. D., Huang, D. Q., Kulkarni, A. V., Gopal, P., Parikh, N. D., Kanwal, F., Patel, M. S., & Singal, A. G. (2025). Older Age But Not Comorbidity Is Associated With Worse Survival in Patients With Hepatocellular Carcinoma. Clinical Gastroenterology and Hepatology, 23(8), 1377-1386. https://doi.org/10.1016/j.cgh.2024.10.015
Kern, L., Geier, A., & Kudlich, T. (2017). Validierung relevanter Prognosefaktoren des Leberzellkarzinoms in Bezug auf Therapiestrategie und Outcome. Zeitschrift Für Gastroenterologie, 55(5), 1-27. https://doi.org/10.1055/s-0037-1603050
Kim, D. S., Kim, B. K., Lee, J. S., Lee, H. W., Park, J. Y., Kim, D. Y., Ahn, S. H., & Kim, S. U. (2021). Validation of Pre-/Post-TACE-Predict Models among Patients with Hepatocellular Carcinoma Receiving Transarterial Chemoembolization. Cancers, 14(1), 67. https://doi.org/10.3390/cancers14010067
Kim, E., & Viatour, P. (2020). Hepatocellular carcinoma: old friends and new tricks. Experimental & Molecular Medicine, 52(12), 1898-1907. https://doi.org/10.1038/s12276-020-00527-1
Kocyigit, A., Dicle, O., Goktay, Y., & Astarcioglu, I. (2014). The effect of using different embolic agents on survival in transarterial chemoembolization of hepatocellular carcinoma: gelfoam versus polyvinyl alcohol. Diagnostic and Interventional Radiology, 20(4), 323-329. https://doi.org/10.5152/dir.2014.13462
Kotsifa, E., Vergadis, C., Vailas, M., Machairas, N., Kykalos, S., Damaskos, C., Garmpis, N., Lianos, G. D., & Schizas, D. (2022). Transarterial Chemoembolization for Hepatocellular Carcinoma: Why, When, How? Journal of Personalized Medicine, 12(3), 436. https://doi.org/10.3390/jpm12030436
Lai, M.-W., Chu, Y.-D., Lin, C.-L., Chien, R.-N., Yeh, T.-S., Pan, T.-L., Ke, P.-Y., Lin, K.-H., & Yeh, C.-T. (2019). Is there a sex difference in postoperative prognosis of hepatocellular carcinoma? BMC Cancer, 19(1), 250. https://doi.org/10.1186/s12885-019-5453-3
Lam, A., Fernando, D., Sirlin, C. C., Nayyar, M., Goodwin, S. C., Imagawa, D. K., & Lall, C. (2017). Value of the portal venous phase in evaluation of treated hepatocellular carcinoma following transcatheter arterial chemoembolisation. Clinical Radiology, 72(11), 994.e9-994.e16. https://doi.org/10.1016/j.crad.2017.07.003
Lawson, A., Kamarajah, S. K., Parente, A., Pufal, K., Sundareyan, R., Pawlik, T. M., Ma, Y. T., Shah, T., Kharkhanis, S., & Dasari, B. V. M. (2023). Outcomes of Transarterial Embolisation (TAE) vs. Transarterial Chemoembolisation (TACE) for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Cancers, 15(12), 3166. https://doi.org/10.3390/cancers15123166
Lee, E. W., & Khan, S. (2017). Recent advances in transarterial embolotherapies in the treatment of hepatocellular carcinoma. Clinical and Molecular Hepatology, 23(4), 265-272. https://doi.org/10.3350/cmh.2017.0111
Lee, M., & Shin, H. P. (2023). Efficacy of Transarterial Chemoembolization (TACE) for Early-Stage Hepatocellular Carcinoma. Medicina, 59(12), 2174. https://doi.org/10.3390/medicina59122174
Lee, S.-Y., Ou, H.-Y., Yu, C.-Y., Huang, T.-L., Tsang, L. L.-C., & Cheng, Y.-F. (2020). Drug-eluting bead transarterial chemoembolization for hepatocellular carcinoma: does size really matter? Diagnostic and Interventional Radiology, 26(3), 230-235. https://doi.org/10.5152/dir.2019.19261
Lee, Y. K., Kim, S. U., Kim, D. Y., Ahn, S. H., Lee, K. H., Lee, D. Y., Han, K.-H., Chon, C. Y., & Park, J. Y. (2013). Prognostic value of α-fetoprotein and des-γ-carboxy prothrombin responses in patients with hepatocellular carcinoma treated with transarterial chemoembolization. BMC Cancer, 13(1), 5. https://doi.org/10.1186/1471-2407-13-5
Leng, B., Diao, L., You, R., YU, Z., Xu, Q., & Yin, G. (2023). Transarterial chemoembolization for advanced hepatocellular carcinoma after failure of first-line systemic treatment: a single-center case series. https://doi.org/10.21203/rs.3.rs-3338340/v1
Lewis, A. L., Dreher, M. R., O’Byrne, V., Grey, D., Caine, M., Dunn, A., Tang, Y., Hall, B., Fowers, K. D., Johnson, C. G., Sharma, K. V., & Wood, B. J. (2016). DC BeadM1TM: towards an optimal transcatheter hepatic tumour therapy. Journal of Materials Science: Materials in Medicine, 27(1), 13. https://doi.org/10.1007/s10856-015-5629-6
Li, H., Zhang, X., Zhao, W., Cai, F., Qin, J., & Tian, J. (2023). Efficacy of CalliSpheres® microspheres versus conventional transarterial chemoembolization in the treatment of refractory colorectal cancer liver metastasis. BMC Cancer, 23(1), 970. https://doi.org/10.1186/s12885-023-11350-y
Li, S., Saviano, A., Erstad, D. J., Hoshida, Y., Fuchs, B. C., Baumert, T., & Tanabe, K. K. (2020). Risk Factors, Pathogenesis, and Strategies for Hepatocellular Carcinoma Prevention: Emphasis on Secondary Prevention and Its Translational Challenges. Journal of Clinical Medicine, 9(12), 3817. https://doi.org/10.3390/jcm9123817
Li, Z.-W., Ren, A.-H., Yang, D.-W., Xu, H., Wei, J., Yuan, C.-W., Wang, Z.-C., & Yang, Z.-H. (2022). Preoperatively predicting early response of HCC to TACE using clinical indicators and MRI features. BMC Medical Imaging, 22(1), 176. https://doi.org/10.1186/s12880-022-00900-8
Liang, B., Makamure, J., Shu, S., Zhang, L., Sun, T., & Zheng, C. (2021). Treatment Response, Survival, and Safety of Transarterial Chemoembolization With CalliSpheres® Microspheres Versus Conventional Transarterial Chemoembolization in Hepatocellular Carcinoma: A Meta-Analysis. Frontiers in Oncology, 11. https://doi.org/10.3389/fonc.2021.576232
Lin, C.-Y., Liu, Y.-S., Pan, K.-T., Chen, C.-B., Hung, C.-F., & Chou, C.-T. (2021). The short-term safety and efficacy of TANDEM microspheres of various sizes and doxorubicin loading concentrations for hepatocellular carcinoma treatment. Scientific Reports, 11(1), 12277. https://doi.org/10.1038/s41598-021-91021-9
Lin, S., Song, Z., Chen, P., Yu, X., Xie, W., Hua, Y., Li, S., Shen, S., & Kuang, M. (2025). Conversion Therapy Based on TACE/HAIC-Based Treatment to Improve the Therapeutic Effect of Initially Unresectable Hepatocellular Carcinoma. Liver Cancer, 1-31. https://doi.org/10.1159/000547725
Liu, B., Gao, S., Guo, J., Kou, F., Liu, S., Zhang, X., Wang, X., Cao, G., Chen, H., Liu, P., Xu, H., Gao, Q., Yang, R., & Zhu, X. (2023). A Novel Nomogram for Predicting the Overall Survival in Patients with Unresectable HCC after TACE plus Hepatic Arterial Infusion Chemotherapy. Translational Oncology, 34, 101705. https://doi.org/10.1016/j.tranon.2023.101705
Lonardo, A., Ballestri, S., Chow, P. K. H., & Suzuki, A. (2020). Sex disparity in hepatocellular carcinoma owing to NAFLD and non-NAFLD etiology: epidemiological findings and pathobiological mechanisms. Hepatoma Research, 6, 83. https://doi.org/10.20517/2394-5079.2020.89
Louisa, J., I Wayan Juli Sumadi, Herman Saputra, & Ni Putu Ekawati. (2023). Profil klinikopatologi karsinoma prostat di Rumah Sakit Umum Pusat Prof. Dr. I.G.N.G. Ngoerah Denpasar periode tahun 2017-2020. Intisari Sains Medis, 14(1), 118-123. https://doi.org/10.15562/ism.v14i1.1593
Macias, R. I. R., Monte, M. J., Serrano, M. A., González-Santiago, J. M., Martín-Arribas, I., Simão, A. L., Castro, R. E., González-Gallego, J., Mauriz, J. L., & Marin, J. J. G. (2021). Impact of aging on primary liver cancer: epidemiology, pathogenesis and therapeutics. Aging, 13(19), 23416-23434. https://doi.org/10.18632/aging.203620
Maimunah, U., Pitoyo, F. L. H., Sarastika, H. Y., Nusi, I. A., Purbayu, H., Sugihartono, T., Kholili, U., Widodo, B., Miftahussurur, M., Thamrin, H., Vidyani, A., & Setiawan, P. B. (2020). Assessment for Retreatment with Trans arterial Chemoembolization Score Effectiveness for Selecting Hepatocellular Carcinoma Patients Undergoing Repeated Therapy (ART Score Predicting Repeated TACE Impact on Overall Survival). Systematic Reviews in Pharmacy, 11(5), 209-215. https://doi.org/10.31838/srp.2020.5.32
Mardian, Y., Yano, Y., Ratnasari, N., Choridah, L., Wasityastuti, W., Setyawan, N. H., & Hayashi, Y. (2019). “Sarcopenia and intramuscular fat deposition are associated with poor survival in Indonesian patients with hepatocellular carcinoma: a retrospective study.” BMC Gastroenterology, 19(1), 229. https://doi.org/10.1186/s12876-019-1152-4
Martani, I. P., Sitanggang, F., Margiani, N., Widiana, I. G., Asih, M., & Ayusta, I. M. (2022). Correlation of Abdominal CT scan Score and Alpha-fetoprotein Levels in Hepatocellular Carcinoma. International Journal of Integrated Health Sciences, 10(2), 88-93. https://doi.org/10.15850/ijihs.v10n2.2768
Mishra, G., Dev, A., Paul, E., Kemp, W., Majeed, A., Lubel, J., Bell, S., Gow, P., Nicoll, A., Sood, S., Thompson, A., Ryan, M., & Roberts, S. K. (2021). Prognostic factors associated with survival in patients with hepatocellular carcinoma undergoing transarterial chemoembolisation: an Australian multicenter cohort study. Hepatoma Research. https://doi.org/10.20517/2394-5079.2021.37
Miyaaki, H. (2011). Clinical characteristics of hepatocellular carcinoma in elderly patients. Oncology Letters, 2, 851-854. https://doi.org/10.3892/ol.2011.359
Montalvo-Javé, E. E., Hoyos-Lazaro, A. E., Espejel-Deloiza, M., Chernitzky-Camaño, J., Rodríguez-Báez, A., & Ortega-León, L. H. (2020). Actualidades en la sobrevida del carcinoma hepatocelular. Cirugía y Cirujanos, 89(1), 104-114. https://doi.org/10.24875/CIRU.19001375
Motola-Kuba, D., Zamora-Valdés, D., Uribe, M., & Méndez-Sánchez, N. (2006). Hepatocellular carcinoma. An overview. Annals of Hepatology, 5(1), 16-24. https://doi.org/10.1016/S1665-2681(19)32034-4
Mu, L., Chapiro, J., Stringam, J., & Geschwind, J.-F. (2016). Interventional Oncology in Hepatocellular Carcinoma. The Cancer Journal, 22(6), 365-372. https://doi.org/10.1097/PPO.0000000000000227
Nainggolan, F. T., Suprianto, I., & . L. (2025). Correlation of Alpha-Fetoprotein Levels with ThreePhase Contrast CT-Scan Finding in Hepatocellular Carcinoma Patients at Dr. Mohammad Hoesin General Hospital Palembangin 2022 - 2023. The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy, 26(2), 114-119. https://doi.org/10.24871/2622025114-119
Nevola, R., Tortorella, G., Rosato, V., Rinaldi, L., Imbriani, S., Perillo, P., Mastrocinque, D., La Montagna, M., Russo, A., Di Lorenzo, G., Alfano, M., Rocco, M., Ricozzi, C., Gjeloshi, K., Sasso, F. C., Marfella, R., Marrone, A., Kondili, L. A., Esposito, N., … Cozzolino, D. (2023). Gender Differences in the Pathogenesis and Risk Factors of Hepatocellular Carcinoma. Biology, 12(7), 984. https://doi.org/10.3390/biology12070984
Ng, J., & Wu, J. (2012). Hepatitis B- and Hepatitis C-Related Hepatocellular Carcinomas in the United States: Similarities and Differences. Hepatitis Monthly, 12(10), e7635. https://doi.org/10.5812/hepatmon.7635
Nishikawa, H., Kimura, T., Kita, R., & Osaki, Y. (2013). Treatment for Hepatocellular Carcinoma in Elderly Patients: A Literature Review. Journal of Cancer, 4(8), 635-643. https://doi.org/10.7150/jca.7279
Nordenstedt, H., White, D. L., & El-Serag, H. B. (2010). The changing pattern of epidemiology in hepatocellular carcinoma. Digestive and Liver Disease, 42, S206-S214. https://doi.org/10.1016/S1590-8658(10)60507-5
O’Donohoe, R. L., Kavanagh, R. G., Cahalane, A. M., Houlihan, D. D., McCann, J. W., & Ryan, E. R. (2019). C-arm cone-beam CT parenchymal blood volume imaging for transarterial chemoembolization of hepatocellular carcinoma: implications for treatment planning and response. European Radiology Experimental, 3(1), 21. https://doi.org/10.1186/s41747-019-0099-0
Papis, D., Vagliasindi, A., & Maida, P. (2020). Hepatobiliary and pancreatic surgery in the elderly: Current status. Annals of Hepato-Biliary-Pancreatic Surgery, 24(1), 1-5. https://doi.org/10.14701/ahbps.2020.24.1.1
Patel, N., Yopp, A. C., & Singal, A. G. (2015). Diagnostic Delays Are Common Among Patients With Hepatocellular Carcinoma. Journal of the National Comprehensive Cancer Network, 13(5), 543-549. https://doi.org/10.6004/jnccn.2015.0074
Pham, T. M. T. (2019). Evaluation of combination ultrasound, shear wave elastography and serum biomarkers in the ultra-early diagnosis of hepatocellular carcinoma. Sorbonne University.
Qi, X., Liu, J., Liu, T., & Hao, H. (2025). Personalized peripheral vascular interventional embolization for tumor: tailoring treatment to improve outcomes. Frontiers in Medicine, 12. https://doi.org/10.3389/fmed.2025.1621148
Rabei, R., Vakil, P., King, B., Lokken, R. P., Heller, M., Fidelman, N., & Kohi, M. (2023). Frailty as a Predictor of Complications and Transplant-Free Survival after Transarterial Chemoembolization of Hepatocellular Carcinoma. Journal of Clinical Interventional Radiology ISVIR, 7(1), 27-33. https://doi.org/10.1055/s-0042-1745775
Rahadiani, N., Andhini Retnowulan, I., Stephanie, M., Rini Handjari, D., & Krisnuhoni, E. (2021). β-Catenin Expression and Its Association with Prognostic Factors in Hepatocellular Carcinoma: A Study on Alpha-fetoprotein, Histologic Grade, and Microvascular Invasion. Open Access Macedonian Journal of Medical Sciences, 9(A), 887-893. https://doi.org/10.3889/oamjms.2021.6123
Rinke, A., Wiedenmann, B., Auernhammer, C., Bartenstein, P., Bartsch, D. K., Begum, N., Faiss, S., Fottner, C., Gebauer, B., Goretzki, P., Lynen Jansen, P., Pöpperl, G., Scherübl, H., Weber, M. M., Gress, T. M., & Pavel, M. (2018). S2k-Leitlinie Neuroendokrine Tumore. Zeitschrift Für Gastroenterologie, 56(6), 583-681. https://doi.org/10.1055/a-0604-2924
Sattler, T., Bredt, C., Surwald, S., Rust, C., Rieger, J., & Jakobs, T. (2018). Efficacy and Safety of Drug Eluting Bead TACE with Microspheres <150 μm for the Treatment of Hepatocellular Carcinoma. Anticancer Research, 38(2), 1025-1032. https://doi.org/10.21873/anticanres.12318
Septiarini, N. A., Wardhani, P., Maimunah, U., & Indrasari, Y. N. (2024). Demographics, risk factors, clinical manifestations, staging and liver function tests of hepatocellular Carcinoma: A literature review. World Journal of Advanced Research and Reviews, 24(3), 2087-2093. https://doi.org/10.30574/wjarr.2024.24.3.3853
Shawon, M. A.-A., Yousuf, M. A. K., Raheem, E., Ahmed, S., Dipti, T. T., Hoque, M. R., Taniguchi, H., & Karim, M. R. (2020). Epidemiology, clinical features, and impact of food habits on the risk of hepatocellular carcinoma: A case-control study in Bangladesh. PLOS ONE, 15(4), e0232121. https://doi.org/10.1371/journal.pone.0232121
Shi, Z., Wang, D., Kang, T., Yi, R., Cui, L., & Jiang, H. (2023). Comparison of CalliSpheres ® microspheres drug-eluting beads and conventional transarterial chemoembolization in hepatocellular carcinoma patients: a randomized controlled trial. Radiology and Oncology, 57(1), 70-79. https://doi.org/10.2478/raon-2023-0001
Sun, H., Wang, H., Wang, Y., Zhong, W., Meng, Y., Lv, Z., Guo, W., & Han, B. (2023). Adjuvant transarterial chemoembolization timing after radical resection is an independent prognostic factor for patients with hepatocellular carcinoma. Frontiers in Oncology, 13. https://doi.org/10.3389/fonc.2023.1129065
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209-249.
Taiji, R., Lin, Y.-M., Chintalapani, G., Lin, E. Y., Huang, S. Y., Mahvash, A., Avritscher, R., Liu, C.-A., Lee, R.-C., Resende, V., Nishiofuku, H., Tanaka, T., Kichikawa, K., Klotz, E., Gupta, S., & Odisio, B. C. (2023). A novel method for predicting hepatocellular carcinoma response to chemoembolization using an intraprocedural CT hepatic arteriography-based enhancement mapping: a proof-of-concept analysis. European Radiology Experimental, 7(1), 4. https://doi.org/10.1186/s41747-022-00315-8
Van Der Gucht, A., Jreige, M., Denys, A., Blanc-Durand, P., Boubaker, A., Pomoni, A., Mitsakis, P., Silva-Monteiro, M., Gnesin, S., Lalonde, M. N., Duran, R., Prior, J. O., & Schaefer, N. (2017). Resin Versus Glass Microspheres for 90 Y Transarterial Radioembolization: Comparing Survival in Unresectable Hepatocellular Carcinoma Using Pretreatment Partition Model Dosimetry. Journal of Nuclear Medicine, 58(8), 1334-1340. https://doi.org/10.2967/jnumed.116.184713
Vogl, T. J., Gruber-Rouh, T., Naguib, N. N. N., Lingwal, N., & Bolik, P. (2024). Liver metastases of neuroendocrine tumors: Conventional transarterial chemoembolization and thermal ablation. RöFo - Fortschritte Auf Dem Gebiet Der Röntgenstrahlen Und Der Bildgebenden Verfahren, 196(4), 381-389. https://doi.org/10.1055/a-2193-0722
Wang, C., Xia, J., Yang, Z., Zhou, W., Chen, W., Qi, C., Gu, J., & Wang, Q. (2020). Transarterial chemoembolization with medium-sized doxorubicin-eluting Callisphere is safe and effective for patients with hepatocellular carcinoma. Scientific Reports, 10(1), 4434. https://doi.org/10.1038/s41598-020-61209-6
Zhou, S., Zhou, G., Shen, Y., Xia, T., Zhao, B., Sun, Z., Gao, L., Li, B., Wang, W., Zhang, S., Opara, N. C., Chen, X., Ju, S., & Wang, Y.-C. (2025). LI-RADS Nonradiation Treatment Response Algorithm Version 2024: Diagnostic Performance and Impact of Ancillary Features. American Journal of Roentgenology, 224(2). https://doi.org/10.2214/AJR.24.32035












