Hepatic arterial embolization for unresectable hepatocellular carcinomas: do technical factors affect prognosis?
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To evaluate retrospectively whether technical factors of hepatic arterial embolization affect the prognosis of patients with hepatocellular carcinoma (HCC).
Materials and methods
Inclusion criteria of this study were the following: (1) patients received embolization as the initial treatment during 2003–2004, (2) Child A or B liver profile, (3) five or fewer HCCs with maximum diameter of 7 cm or smaller, and (4) no extrahepatic metastasis. Patient data were gathered from 43 centers. Prognostic factors were evaluated using univariate and multivariate analyses.
Eight hundred fifteen patients were enrolled. The 1-, 3-, 5-, and 7-year overall survival rates were 92.0 % (95 % CI 90.1–93.9), 62.9 % (95 % CI 59.3–66.6), 39.0 % (95 % CI 35.1–43.0), and 26.7 % (95 % CI 22.6–30.8) in all patients. Univariate analysis showed a Child-Pugh class-A, alpha-fetoprotein level lower than 100 ng/ml, tumor size of 3 cm or smaller, tumor number of 3 or fewer, one-lobe tumor distribution, nodular tumor type, within the Milan criteria, stage I or II, no portal venous invasion, use of iodized oil, and selective embolization were significantly better prognostic factors. In the multivariate Cox model, the benefit to survival of selective embolization remained significant (hazard ratio 0.68; 95 % CI 0.48–0.97; p = 0.033).
Selective embolization contributes to survival in patients with HCCs.
KeywordsHepatocellular carcinoma Arterial embolization Prognosis
We thank the following institutions and doctors for supporting this study: (1) Okitama Public General Hospital, Department of Radiology, Hitoshi Ito, MD, (2) Toho University Omori Hospital, Department of Department of Gastroenterology and Hepatology, Manabu Watanabe, MD, (3) National Center for Global Health and Medicine, Department of Radiology, Kanehiro Hasuo, MD, (4) Tokai University, Department of Radiology, Takeshi Hashimoto, MD, (5) Yamanashi University, Department of Radiology, Hiroki Okada, MD, (6) Shinshu University, Department of Radiology, Kazuhiko Ueda, MD, (7) Kouseiren Takaoka Hospital, Department of Radiology, Koji Nobata, MD, (8) Ishikawa Prefectural Central Hospital, Department of Radiology, Takeshi Kobayashi, MD, (9) Hamamatsu University School of Medicine, Department of Radiology, Mika Kamiya, MD, (10) Nagoya City University, Department of Radiology, Masashi Shimohira, MD, (11) Aichi Medical University, Department of Radiology, Seiji Kamei, MD, (12) Shiga University of Medical Science, Department of Radiology, Norihisa Nitta, MD, (13) Kohka Public Hospital, Department of Radiology, Michio Yamasaki, MD, (14) Japanese Red Cross Kobe Hospital, Department of Radiology, Koji Sugimoto, MD, (15) Nishi-Kobe Medical Center, Department of Radiology, Yoichiro Kuwata, MD, (16) Wakayama Medical University, Department of Radiology, Nobuyuki Kawai, MD, (17) Hiroshima University, Department of Radiology, Hideaki Kakizawa, MD, (18) Chugoku Rosai Hospital, Department of Radiology, Akira Naito, MD, (19) Tottori University, Department of Radiology, Toshio Kamino, MD, (20) Shimane University, Department of Radiology, Msakatsu Tsurusaki, MD, (21) Oita University, Department of Radiology, Hiromu Mori, MD, (22) Kumamoto University, Department of Radiology, Osamu Ikeda, MD, (23) Kagoshima University, Department of Radiology, Yasutaka Baba, MD, (24) Kanazawa University, Department of Radiology, Tetsuya Minami, MD, (25) Hokkaido University, Department of Radiology, Daisuke Abo, MD, (26) Okayama University, Department of Radiology, Hideo Gobara, MD, (27) Osaka University, Department of Radiology, Keigo Osuga, MD, (28) National Cancer Center, Department of Radiology, Yoshito Takeuchi, (29) Teikyo University, Department of Radiology, Hiroshi Kotake, MD, (30) Japan Red Cross Kyoto Daiichi Hospital, Department of Radiology, Hiroyuki Morishita, MD, (31) Kochi Health Science Center, Department of Radiology, Yasuhiro Hata, MD, (32) Nanbu Medical Center, Department of Radiology, Fumikiyo Ganaha, MD, and (33) Keio University, Department of Diagnostic Radiology, Sachio Kuribayashi, MD.
Conflict of interest
The authors declare that they have no conflict of interest.
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