Comparison of Overall Survival between Transarterial Chemoembolization and Best Supportive Care in Intermediate- Stage Hepatocellular Carcinoma

Abstract

Objective:The Thailand management guideline allows the use of transarterial chemoembolization (TACE) for the treatment of intermediate-stage hepatocellular carcinoma (HCC) in patients with decompensated cirrhosis, whereas other guidelines do not. The aim of this study was to compare the overall survival between TACE and the best supportive care (BSC) in HCC patients with Child-Pugh score 5-8 cirrhosis and in subgroups with compensated cirrhosis (Child-Pugh score 5-6) and early decompensated cirrhosis (Child-Pugh score 7-8). Methods: This retrospective study comprised 118 patients with intermediate-stage HCC. The overall survival was compared between TACE and BSC using the Kaplan-Meier method. Results: The median overall survival time for all patients was 21.4 months in the TACE group and 8.2 months in the BSC group (P <0.001). In the subgroup analyses, the overall survival times for TACE and BSC were 26 months and 9 months, respectively, for compensated cirrhosis (P <0.001), and 14.5 months and 6.9 months, respectively, for early decompensated cirrhosis (P <0.001). In the Cox proportional-hazards model, TACE was an independent prognostic factor for prolonged overall survival in all patients [hazard ratio (HR) 0.29; 95% confidence interval (CI), 0.17-0.49; P <0.001], patients with compensated cirrhosis (HR, 0.31; 95% CI, 0.16-0.62; P <0.001), and patients with early decompensated cirrhosis (HR, 0.16; 95% CI, 0.061-0.44; P <0.001). Conclusion: TACE improves the overall survival in patients with intermediate-stage HCC and compensated or early decompensated cirrhosis.

Retrospective Long-Term Evaluation of Conventional Transarterial Chemoembolization for Hepatocellular Carcinoma over 20 Years

“…There are many studies that investigated TACE as a treatment for HCC in different settings. For example, Kong et al [29] and Akarapatima et al [30] found that TACE significantly improves the survival time of HCC patients compared to the best supportive care. In our study the best survival times were reported in patients treated neoadjuvantly with TACE, followed by other treatments including ablation and surgery.…”

Therapieentscheidungen beim hepatozellulären Karzinom: Erkenntnisse aus der TRENDY-Studie

“…Bei Betroffenen, die für einen chirurgischen Eingriff oder eine RFA nicht infrage kommen oder diese ablehnen, stellt die Wahl der optimalen Behandlung eine große Herausforderung dar. Die transarterielle Chemoembolisation (TACE) ist zwar als lokale Behandlungsoption für inoperable HCC etabliert, doch die Verbesserung der onkologischen Endpunkte im Vergleich zu einer rein supportiven Therapie bleibt moderat [ 1 ]. Vielversprechende Ergebnisse konnten mit der stereotaktischen Strahlentherapie (SBRT) bei inoperablem oder rezidivierendem HCC erreicht werden [ 2 , 7 , 8 ].…”

Prevalence of Hepatocellular Carcinoma in Hepatitis B Population within Southeast Asia: A Systematic Review and Meta-Analysis of 39,050 Participants

“…Southeast Asia exhibits distinctive epidemiological patterns regarding the frequency of HCC in HBV patients. This variation is influenced by several variables, such as virus genotypes, host immune responses, environmental conditions, and dietary habits [5][6][7]. Designing efficient prevention and control methods suited to the region's demands requires understanding the complex nature of HCC prevalence and unravelling the underlying mechanisms [4].…”