Predicting survival in patients with liver cancer considered for transarterial chemoembolization

Wigmore, Stephen J.; Redhead, Doris N.; Thomson, Ben; Parks, RW; Garden, O. J.

doi:10.1016/j.ejso.2003.10.007

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…Similarly, O'Suilleabhain et al. (2003) and Wigmore et al. (2004) reported that serum albumin is an independent prognostic factor for better overall survival in patients with HCC considered for chemoembolization.…”

Section: Discussionmentioning

confidence: 88%

“…1 (2) 23 (46) in the median overall survival between both treatment arms was found only in patients with serum albumin >3.3 g/dL, where the median overall survival in the chemoembolization arm was 60 weeks compared with 36 weeks for the systemic chemotherapy arm (P = 0.003). Similarly, O'Suilleabhain et al (2003) and Wigmore et al (2004) reported that serum albumin is an independent prognostic factor for better overall survival in patients with HCC considered for chemoembolization.…”

Section: Discussionmentioning

confidence: 92%

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A randomized controlled trial of transcatheter arterial chemoembolization with lipiodol, doxorubicin and cisplatin versus intravenous doxorubicin for patients with unresectable hepatocellular carcinoma

Mabed

Esmaeel

Elkhodary

et al. 2009

European Journal of Cancer Care

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Hepatocellular carcinoma (HCC) is a major and often therapeutically frustrating oncological problem. A total of 100 patients with unresectable HCC were recruited and randomized to be treated with either transcatheter arterial chemoembolization (TACE) or systemic chemotherapy. Fifty patients were treated with TACE using lipiodol, doxorubicin and cisplatin, while 50 patients were treated with systemic doxorubicin alone. Patients treated with TACE achieved a significantly higher response rate, with partial response achieved in 16 patients (32%) versus five patients (10%) in the chemotherapy arm (P = 0.007). A significantly more favourable tumour response to chemoembolization was found in patients with single lesions (P = 0.02), Child class A (P = 0.007), Okuda stage 1 (P = 0.005) and alpha-feto protein less than 400 ng/mL (P < 0.001). The probability of tumour progression was significantly lower in cases treated with TACE where the median progression free survival was 32 weeks (range, 16-70 weeks) versus 26 weeks (range, 14-54 weeks) for patients treated with systemic chemotherapy (P = 0.03). However, the median overall survival did not differ significantly in cases treated with TACE (38 weeks) compared with those treated with chemotherapy (32 weeks) (P = 0.08), except for patients with serum albumin >3.3 g/dL (60 vs. 36 weeks; P = 0.003). Multivariate Cox regression analysis showed that a rise of serum albumin by 1 g/dL is associated with a decrease in the risk of death by 33% (95% confidence interval: 0.12-0.94, P = 0.038). Mortality in the chemoembolization arm was due to tumour progression in 18 patients (53%), liver failure in 11 patients (32%) and gastro intestinal tract (GIT) bleeding in 5 patients (15%). Mortality in the chemotherapy arm was due to tumour progression in 23 patients (64%), liver failure in 9 patients (25%) and GIT bleeding in 4 patients (11%). Treatment-related mortality was 4% in the TACE arm versus 0% in the chemotherapy arm. In conclusion, the overall survival benefits of TACE and systemic doxorubicin are similar for patients with unresectable HCC amenable to either treatment. It is crucial to optimize the benefit-risk ratio of TACE. In this setting, serum albumin level is a candidate marker for selection of cases who may benefit from this procedure.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 92%

A randomized controlled trial of transcatheter arterial chemoembolization with lipiodol, doxorubicin and cisplatin versus intravenous doxorubicin for patients with unresectable hepatocellular carcinoma

Mabed

Esmaeel

Elkhodary

et al. 2009

European Journal of Cancer Care

View full text Add to dashboard Cite

show abstract

“…Clinical tumour characteristics and outcomes were compared between those with BR after the initial TACE for unresectable disease to those without BR using Student's t ‐test for parametric, continuous data, Mann–Whitney U ‐test for non‐parametric, continuous data, and Fisher’ exact test for all nominal data. From data obtained through the chart review, the Child–Pugh score, model of end‐stage liver disease (MELD) score, and TACE survival score 14 were calculated for each patient. Overall survival was defined as the time from initial TACE therapy to date of death or censored at last follow‐up.…”

Section: Methodsmentioning

confidence: 99%

“…[8][9][10][11] As expected outcomes are best in patients with compensated or Child's A cirrhosis, TACE has also been used by some in properly selected patients with more advanced cirrhosis. 12 Favourable outcomes from TACE are associated with Child's Class A cirrhosis 13 lack of ascites, 13 age younger than 60 years, 14 alkaline phosphatase less than 120 U/l, 14 albumin greater than 35 g/l, 14 smaller tumours, 15 solitary tumours, 15 good baseline performance status, 16 low billirubin level, 7,16 and multiple TACE procedures. 15,16 A best or complete radiological response to TACE has been defined as a lack of contrast enhancement on imaging after the procedure.…”

Section: Introductionmentioning

confidence: 99%