Multivariate analysis of prognostic factors for survival following doxorubicin-eluting bead transarterial chemoembolization for hepatocellular carcinoma

Marty T. Sellers, Sidney Huggins, Kristy Kegley, Harrison S. Pollinger, Roshan Shrestha, Mark W. Johnson, Lance L. Stein, Chakri Panjala, Miguel Tan, Aravind Arepally, Louis Jacobs, Christopher Caldwell, Michael Bosley, Steven J. Citron

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)647-654
Number of pages8
JournalJournal of Vascular and Interventional Radiology
Volume24
Issue number5
DOIs
StatePublished - May 2013

Keywords

  • AFP
  • BCLC
  • Barcelona Clinic Liver Cancer
  • CI
  • CTP
  • Child-Turcotte-Pugh
  • DEB
  • ECOG
  • Eastern Cooperative Oncology Group
  • HCC
  • HR
  • INR
  • International Normalized Ratio
  • MELD
  • Model for End-stage Liver Disease
  • PS
  • PVI
  • RAdv
  • confidence interval
  • doxorubicin-eluting bead
  • hazard ratio
  • hepatocellular carcinoma
  • performance status
  • portal vein invasion
  • radiographically advanced
  • α-fetoprotein

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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