Transarterial Chemoembolization for the Treatment of Advanced-Stage Hepatocellular Carcinoma

Yan Zhao, Rafael Duran, Julius Chapiro, Jae Ho Sohn, Sonia Sahu, Florian Fleckenstein, Susanne Smolka, Timothy M. Pawlik, Rüdiger Schernthaner, Li Zhao, Howard Lee, Shuixiang He, Ming De Lin, Jean François Geschwind

Research output: Contribution to journalArticlepeer-review

Abstract

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. Five hundred eight patients with Barcelona Clinic Liver Cancer (BCLC) C-stage HCC, Child-Pugh A/B who were treated with TACE between November 1998 and December 2013 were identified. 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 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 ≥400 ng/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 cutoff 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). 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.

Original languageEnglish (US)
Pages (from-to)2002-2009
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume20
Issue number12
DOIs
StatePublished - Dec 1 2016

Keywords

  • Barcelona Clinic Liver Cancer
  • Hepatocellular carcinoma
  • Overall survival
  • Transarterial chemoembolization

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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