Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma in Patients With Child's Grade A or B Cirrhosis

Abstract

We evaluated factors affecting long-term survival after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) complicating cirrhosis. One hundred eighty-two patients with Child's class A or B cirrhosis and an HCC, not amenable to surgery or percutaneous ethanol injection, underwent 346 TACEs (mean 1.9) with epirubicin, iodized oil, and gelatin sponge. Many prognostic factors were subjected to univariate analysis and thereafter, when significant, to the Cox's hazard proportional model. Finally, the significant indices in the Cox's model were used to estimate the accuracy of the probability of death with computation of the area under the receiving operative characteristic (ROC) curve. The cumulative survival rates at 1, 2, 3, and 5 years were 0.83, 0.52, 0.40, and 0.16, respectively. According to Cox's model, the factors associated with significantly worse survival were the presence of ascites (p = 0.0027), elevated bilirubin levels (p = 0.0163), elevated alpha-fetoprotein (alphaFP) values (p = 0.0067), a tumor greater than 5 cm in diameter (p = 0.0001), and the absence of a tumor capsule-like rim (p = 0.0278). According to these parameters, the accuracy of the probability of death estimated with ROC analysis was 0.63. Minor and major complications occurred in 82 patients (45%) and caused death in 2 patients. Long-term prognosis after TACE for HCCs in patients with Child's class A or B cirrhosis depends on the presence of ascites, the bilirubin level, the alphaFP value, the diameter of the tumor, and the presence of a tumor capsule-like rim. However, when considered altogether, these variables are poor predictors to evaluate survival, and other factors should be investigated to identify subjects more responsive to TACE. Complications occur in a high percentage of patients, but they do not affect long-term prognosis.

Prognostic Index for Survival in Patients After Treatment for Primary Hepatocellular Carcinoma

“…Ascites has been reported to be a poor prognosis factor by Savastano et al [23]. In our study, the hazard ratio was 2.727.…”

“…The number of tumor lesions and the diameter of the tumor have also been reported as poor prognosis factors in other studies [21][22][23][24]. It is known that HCC elevates the degree of malignancy from a well-differentiated to a moderately or poorly differentiated tumor concomitantly with an increase in the diameter of the tumor.…”

Prospective Study on the Survival of HCC Patients Treated with Transcatheter Arterial Lipiodol Chemoembolization

“…Previous study showed that the reduced serum level of AFP after intervention, the number of TACE procedures, small tumor size anda homogenous tumor uptake are related to the prognosis of patients treated with TACE (Okuda et al, 1984;Mondazzi et al, 1994;Farinati et al, 1996;Savastano et al, 1999;Lee et al, 2002;Lopez et al, 2002), which showed the difference on the prognosis of HCC could be due to ethnicity, characteristics of patients or chance.…”

Degradable Starch Microspheres versus Ethiodol and Doxorubicin in Transarterial Chemoembolization of Hepatocellular Carcinoma

“…Transarterial chemoembolization in combination with embolic agents such as gelatin particles may cause considerable side effects (23). Because of their less permanent occlusion of blood flow, DSMs are expected to reduce toxicity levels and adverse events (24,25).…”