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Transarterial chemoembolization can prolong survival for patients with metastatic hepatocellular carcinoma: a propensity score matching analysis

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Abstract

Background

In Asian countries, transarterial chemoembolization (TACE) is widely applied in hepatocellular carcinoma (HCC) patients with extra-hepatic metastasis in the absence of main portal vein thrombosis. However, its survival benefit is unclear. The study aimed to analyze the role of TACE in patients with metastatic HCC.

Methods

From 2002 to 2009, 2,165 consecutive HCC patients were retrospectively reviewed. Of the 893 Barcelona Clinic Liver Cancer stage C patients, 105 who had extra-hepatic metastasis on initial presentation without main portal vein thrombosis were enrolled, including 46 who received TACE (TACE group) and 59 who received supportive treatment (control group). Factors associated with survival were evaluated by multivariate analysis. Survival between the two groups was compared by propensity score matching analysis.

Results

Median survival in the TACE and control groups was 6.6 and 3.2 months, respectively (p < 0.001). By multivariate analysis, TACE [hazard ratio (HR) = 0.476, p = 0.002], tumor size >10 cm (HR = 1.606, p = 0.045), and alpha-fetoprotein (AFP) >2,000 ng ml−1 (HR = 1.599, p = 0.037) were factors associated with survival. After propensity score matching analysis, a better survival was noted in the TACE group (median survival 4.0 vs. 3.0 months, p = 0.029). Subgroup analysis showed that patients with tumor size ≤10 cm and AFP levels ≤2,000 ng ml−1 had the best survival from TACE. Smaller tumor size is the only independent predictor for survival longer than 6 months in patients receiving TACE.

Conclusions

TACE provides survival benefit for metastatic HCC patients. Prospective randomized controlled trials are warranted to delineate the role of combining TACE with sorafenib or other treatment for metastatic HCC.

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Acknowledgements

The study was supported by grants from the National Science Council (NSC 97-2314-B-010-023-MY3) and Taipei Veterans General Hospital (VGH 98A-026, V97S5-002, V98C1-057, V99C1-075, V99A-152, DOH 99-TD-C-111-007 and DOH 100-TD-C-111-007), Taipei, Taiwan.

Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan

    I-Cheng Lee, Teh-Ia Huo, Yi-Hsiang Huang, Chung-Pin Li, Pui-Ching Lee, Chien-Wei Su, Keng-Hsin Lan, Chih-Ming Yang, Han-Chieh Lin & Shou-Dong Lee

  2. Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan

    Yee Chao

  3. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Jen-Huey Chiang

  4. Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan

    Jaw-Ching Wu

  5. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    I-Cheng Lee, Yi-Hsiang Huang, Chien-Wei Su & Jaw-Ching Wu

  6. Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Teh-Ia Huo & Keng-Hsin Lan

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  1. I-Cheng Lee
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Correspondence to Yi-Hsiang Huang.

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Lee, IC., Huo, TI., Huang, YH. et al. Transarterial chemoembolization can prolong survival for patients with metastatic hepatocellular carcinoma: a propensity score matching analysis. Hepatol Int 6, 753–762 (2012). https://doi.org/10.1007/s12072-011-9322-7

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  • DOI: https://doi.org/10.1007/s12072-011-9322-7

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