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Transarterial Chemoembolization for the Treatment of Advanced-Stage Hepatocellular Carcinoma

  • Published:
Journal of Gastrointestinal Surgery

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.

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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

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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.

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Authors and Affiliations

  1. Department of Gastroenterology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Yan Zhao, Susanne Smolka & Shuixiang He

  2. Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Chairman’s Office, 333 Cedar Street, TE 2-230, New Haven, CT, 06520, USA

    Yan Zhao, Rafael Duran, Julius Chapiro, Jae Ho Sohn, Sonia Sahu, Florian Fleckenstein, Rüdiger Schernthaner, Li Zhao, Howard Lee, MingDe Lin & Jean-François Geschwind

  3. Department of Surgery, The Ohio State University, Columbus, OH, USA

    Timothy M. Pawlik

  4. U/S Imaging and Interventions (UII), Philips Research North America, Cambridge, MA, USA

    MingDe Lin

Authors
  1. Yan Zhao
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  2. Rafael Duran
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  3. Julius Chapiro
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  7. Susanne Smolka
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  8. Timothy M. Pawlik
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  9. Rüdiger Schernthaner
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  10. Li Zhao
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  11. Howard Lee
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  12. Shuixiang He
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  13. MingDe Lin
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  14. Jean-François Geschwind
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Corresponding author

Correspondence to Jean-François Geschwind.

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Zhao, Y., Duran, R., Chapiro, J. et al. Transarterial Chemoembolization for the Treatment of Advanced-Stage Hepatocellular Carcinoma. J Gastrointest Surg 20, 2002–2009 (2016). https://doi.org/10.1007/s11605-016-3285-x

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  • DOI: https://doi.org/10.1007/s11605-016-3285-x

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