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Journal of Gastrointestinal Surgery

, Volume 20, Issue 12, pp 2002–2009 | Cite as

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
  • MingDe Lin
  • Jean-François Geschwind
Article

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.

Keywords

Hepatocellular carcinoma Transarterial chemoembolization Overall survival Barcelona Clinic Liver Cancer 

Abbreviations

HCC

Hepatocellular carcinoma

BCLC

Barcelona Clinic Liver Cancer

TACE

Transarterial chemoembolization

OS

Overall survival

ECOG

Eastern Cooperative Oncology Group

DEB

Drug-eluting bead

PVTT

Portal vein tumor thrombosis

ROC

Receiver operating characteristic

Notes

Acknowledgments

MingDe Lin is a Philips Employee; Jean-François Geschwind received a grant from Philips Healthcare.

Authorship Statement

Conceived and designed the study: Yan Zhao, Rafael Duran, and Julius Chapiro; collection and analysis of data: Yan Zhao, Jae Ho Sohn, Florian Fleckenstein, Li Zhao, and Howard Lee; Manuscript writing: All authors; Critical revision of the manuscript: Rafael Duran, Julius Chapiro, Timothy M. Pawlik, Sonia Sahu, Rüdiger Schernthaner, Shuixiang He, MingDe Lin, Jean-François H. Geschwind. All authors approved the final manuscript submitted.

Funding

Our study was funded by NIH/NCI R01 CA160771, Philips Research North America, Cambridge, MA.

Compliance with Ethical Standards

Conflicts of Interest

The authors have declared no conflicts of interest.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2016

Authors and Affiliations

  • Yan Zhao
    • 1
    • 2
  • Rafael Duran
    • 2
  • Julius Chapiro
    • 2
  • Jae Ho Sohn
    • 2
  • Sonia Sahu
    • 2
  • Florian Fleckenstein
    • 2
  • Susanne Smolka
    • 1
  • Timothy M. Pawlik
    • 3
  • Rüdiger Schernthaner
    • 2
  • Li Zhao
    • 2
  • Howard Lee
    • 2
  • Shuixiang He
    • 1
  • MingDe Lin
    • 2
    • 4
  • Jean-François Geschwind
    • 2
  1. 1.Department of GastroenterologyFirst Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
  2. 2.Department of Radiology and Biomedical ImagingYale University School of MedicineNew HavenUSA
  3. 3.Department of SurgeryThe Ohio State UniversityColumbusUSA
  4. 4.U/S Imaging and Interventions (UII), Philips Research North AmericaCambridgeUSA

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