Transarterial Chemoembolization for the Treatment of Advanced-Stage Hepatocellular Carcinoma
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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.
KeywordsHepatocellular carcinoma Transarterial chemoembolization Overall survival Barcelona Clinic Liver Cancer
Barcelona Clinic Liver Cancer
Eastern Cooperative Oncology Group
Portal vein tumor thrombosis
Receiver operating characteristic
MingDe Lin is a Philips Employee; Jean-François Geschwind received a grant from Philips Healthcare.
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.
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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