TY - JOUR
T1 - Multivariate analysis of prognostic factors for survival following doxorubicin-eluting bead transarterial chemoembolization for hepatocellular carcinoma
AU - Sellers, Marty T.
AU - Huggins, Sidney
AU - Kegley, Kristy
AU - Pollinger, Harrison S.
AU - Shrestha, Roshan
AU - Johnson, Mark W.
AU - Stein, Lance L.
AU - Panjala, Chakri
AU - Tan, Miguel
AU - Arepally, Aravind
AU - Jacobs, Louis
AU - Caldwell, Christopher
AU - Bosley, Michael
AU - Citron, Steven J.
N1 - Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2013/5
Y1 - 2013/5
N2 - Purpose: To identify prognostic factors for survival in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization with doxorubicin-eluting beads (DEBs). Materials and Methods: In a retrospective, single-center analysis, tumor- and patient-related factors were recorded for univariate and multivariate analyses via Kaplan-Meier and Cox regression. Infiltrative HCC phenotype and portal vein invasion (PVI) were correlated, and patients with either or both were classified as having radiographically advanced (RAdv) HCC. The primary endpoint was overall survival, which was calculated from the time of first DEB chemoembolization procedure. Results: A total of 168 patients underwent 248 procedures, of which 215 (86.7%) were outpatient procedures. Mean length of stay was 0.33 days, and 25 patients (10.1%) were readmitted within 30 days. A total of 33 patients underwent liver transplantation and were excluded from survival analyses. A total of 130 had cirrhosis; 62, 50, and 18 had Child class A, B, and C disease, respectively. Forty-one patients had infiltrative HCC phenotype, 28 of whom also had PVI. Multivariate analysis of survival in all patients showed α-fetoprotein (AFP), performance status (PS), RAdv HCC, Child classification, albumin level, and ascites to predict survival. In patients without RAdv HCC, AFP, PS, Child classification, albumin level, and International Normalized Ratio were independent predictors. Increased bilirubin level was not an independent risk factor for death. Conclusions: Independent prognostic factors in patients with HCC undergoing DEB chemoembolization have been identified. Increased bilirubin level was not an independent risk factor. These data can be used in HCC patient selection and counseling for DEB chemoembolization.
AB - Purpose: To identify prognostic factors for survival in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization with doxorubicin-eluting beads (DEBs). Materials and Methods: In a retrospective, single-center analysis, tumor- and patient-related factors were recorded for univariate and multivariate analyses via Kaplan-Meier and Cox regression. Infiltrative HCC phenotype and portal vein invasion (PVI) were correlated, and patients with either or both were classified as having radiographically advanced (RAdv) HCC. The primary endpoint was overall survival, which was calculated from the time of first DEB chemoembolization procedure. Results: A total of 168 patients underwent 248 procedures, of which 215 (86.7%) were outpatient procedures. Mean length of stay was 0.33 days, and 25 patients (10.1%) were readmitted within 30 days. A total of 33 patients underwent liver transplantation and were excluded from survival analyses. A total of 130 had cirrhosis; 62, 50, and 18 had Child class A, B, and C disease, respectively. Forty-one patients had infiltrative HCC phenotype, 28 of whom also had PVI. Multivariate analysis of survival in all patients showed α-fetoprotein (AFP), performance status (PS), RAdv HCC, Child classification, albumin level, and ascites to predict survival. In patients without RAdv HCC, AFP, PS, Child classification, albumin level, and International Normalized Ratio were independent predictors. Increased bilirubin level was not an independent risk factor for death. Conclusions: Independent prognostic factors in patients with HCC undergoing DEB chemoembolization have been identified. Increased bilirubin level was not an independent risk factor. These data can be used in HCC patient selection and counseling for DEB chemoembolization.
KW - AFP
KW - BCLC
KW - Barcelona Clinic Liver Cancer
KW - CI
KW - CTP
KW - Child-Turcotte-Pugh
KW - DEB
KW - ECOG
KW - Eastern Cooperative Oncology Group
KW - HCC
KW - HR
KW - INR
KW - International Normalized Ratio
KW - MELD
KW - Model for End-stage Liver Disease
KW - PS
KW - PVI
KW - RAdv
KW - confidence interval
KW - doxorubicin-eluting bead
KW - hazard ratio
KW - hepatocellular carcinoma
KW - performance status
KW - portal vein invasion
KW - radiographically advanced
KW - α-fetoprotein
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U2 - 10.1016/j.jvir.2012.12.003
DO - 10.1016/j.jvir.2012.12.003
M3 - Article
C2 - 23384831
AN - SCOPUS:84876942773
VL - 24
SP - 647
EP - 654
JO - Journal of Vascular and Interventional Radiology
JF - Journal of Vascular and Interventional Radiology
SN - 1051-0443
IS - 5
ER -