Transarterial Chemoembolization for the Treatment of Advanced-Stage Hepatocellular Carcinoma

Abstract

Introduction It remains controversial whether transarterial chemoembolization (TACE) should be performed in patients with advanced-stage hepatocellular carcinoma (HCC). The present large retrospective cohort study aimed to define the survival outcome following TACE of advanced HCC and to identify the prognostic factors. Methods 508 patients with Barcelona Clinic Liver Cancer (BCLC) C-stage HCC, Child-Pugh A/B were who were treated with TACE between November 1998 to December 2013 were identified. Results There was no significant difference in overall survival (OS) between patients with Eastern Cooperative Oncology Group (ECOG) 0 and those with ECOG ≥1 (10.5 months vs. 11.9 months, P=0.87). The median OS of patients without portal vein tumor thrombosis (PVTT) was longer than that of patients with PVTT (16.9 months vs. 6.1 months, P<0.001). Child-Pugh B class, PVTT, extrahepatic metastasis, tumor size ≥5 cm, number of tumors ≥3 and alpha-fetoprotein ≥ 400ng/dl were significantly associated with decreased survival and were used for determining the risk scores. All patients were divided into two groups (low-risk and high-risk groups) according to the cut-off value of 6.5 for risk scores. The patients with a value <6.5 (low-risk group) had significantly longer survival than those with >6.5 (high-risk group) (24.1 vs. 7.5 months, respectively; P<0.001). Conclusions TACE is an effective therapy for select patients with advanced stage HCC and may provide equal or improved survival as compared with reported outcomes with sorafenib. The results highlight the need for a differentiated approach to therapeutic recommendations for patients with BCLC C.

Safety and efficacy of transcatheter arterial chemoembolization with embospheres in treatment of hepatocellular carcinoma

“…Although TACE is the standard treatment method for HCC patients at BCLC stage B, there is increasing evidence to support the view that TACE is an effective therapy for advanced HCC patients with vascular invasion or extrahepatic spread. It may provide equal or improved survival, compared with reported outcomes with sorafenib . Selected advanced HCC patients can be treated with TACE according to the Guidelines of Diagnosis, Management, and Treatment of Hepatocellular Carcinoma (vers.…”

“…It may provide equal or improved survival, compared with reported outcomes with sorafenib. 18,19 Selected advanced HCC patients can be treated with TACE according to the Guidelines of Diagnosis, Management, and Treatment of Hepatocellular Carcinoma (vers. 2011) of China.…”

Congenital absence of the portal vein complicated by hepatocellular carcinoma in the liver of an adult woman: review of imaging, literature and management

“…In this case, c-TACE had already been performed at an outside facility. TACE has been shown to be safe and effective in patients with advanced or BCLC C disease which includes patients with varying degrees of PV thrombosis [23,24] . However, PV thrombosis does portend a poorer prognosis [24] .…”

“…TACE has been shown to be safe and effective in patients with advanced or BCLC C disease which includes patients with varying degrees of PV thrombosis [23,24] . However, PV thrombosis does portend a poorer prognosis [24] . As anticipated post embolization syndrome is the most common side effect reported post TACE, while encephalopathy was found in approximately 5% of patients, and elevated liver function tests as high as 20% of cases [23] .…”

Choice of Intra-arterial Therapy for Hepatocellular Carcinoma: Evidence and Future Horizons

“…39 In another study of 508 BCLC C patients treated with cTACE, median OS was 11.9 months. 40 As a comparison, OS in advanced-stage HCC patients treated with sorafenib ranged from 5 to 10.7 months. 10,41 Subgroup analysis of low-risk advanced-stage patients demonstrated even better outcomes as compared with systemic therapy.…”