Transarterial Chemoembolization(tace) Efficacy in Patients With Hepatocellular Carcinoma(hcc): Can Significant Prognostic Factors Be Revealed?

Abstract

Material and methods. A total of 125 patients(pts) with HCC (stage BCLC-B) underwent TACE from 2009 to 2016. If pts had been found inoperable, radiological intervention was used as monotherapy or in combination with systemic therapy at different stages of the disease. Results. Median overall survival (OS) for pts subjected to at least one TACE session was 20.5 months (95 per cent confidence interval 16.4-24.59). Such factors as ECOG status (р=0,012, RR= 1,65), protein synthesis (albumin >37 г/л; р=0,005, RR = 0,47) and detoxication (total bilirubin ≤ 14 мкмоль/л; р=0,037, RR = 1,64) hepatic functions, functional hepatic ability according to Child-Pugh classification (А vs. B; p=0,016, RR = 2,5) ALBI categories (A1 vs. A2 vs. A3; р=0,007, RR = 1,66) as well as HCC invasion: tumour size (р=0,001, RR=2,1), level AFP ≥ 5 IU/ml (р=0,003, RR 2,25), bilobar involvement (р=0,024; RR=1,64) independently influence OS. Pronounced TACE effect (р<0,001, RR 1,93) and Time before Progression duration were found to influence significantly the fatality rate. Multifactorial analysis for OS confirmed increased mortality (RR=1,92) if total bilirubin was ≥14 umol/L (р=0,018); Impaired hepatic functions according to ALBI (р=0,007) and Child-Pugh classification (р=0,002) are associated with significant OS reduction (RR 1.73 и 3,41respectively). HCC invasion (BCLC; р=0,03) AFP level ≥5 IU/ml (р=0,008, RR=2,26) and the biggest tumour node size >10 см (р=0,01, RR 1,95) independently increase mortality rate. Effective TACE (р<0,001) is associated with significant OS increase and mortality decrease. Conclusion. TACE is most effective if HCC pts have satisfactory condition and preserved liver function (Child Pugh A or ALBIA1) and limited intrahepatic invasion (BCLCA/B), with tumour size being... cm and normal AFP level. Under conditions of intrahepatic progression subsequent local therapy was found to be significantly associated with OS increase.