Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence.
OBJECTIVE
The role of transarterial chemoembolization (TACE) for inoperable hepatocellular carcinoma (HCC) has remained controversial, and its efficacy for postresection intrahepatic recurrence has not been fully assessed. A study was performed to evaluate the treatment results and prognostic factors of TACE treatment in these patients.


METHODS
Clinicopathologic data and treatment results of 384 patients with inoperable HCC and 100 patients with postresection recurrent HCC treated with TACE were collected prospectively and analyzed.


RESULTS
TACE was associated with an overall treatment morbidity rate of 23% (112/484) and mortality rate of 4.3% (21/484). A particularly high mortality rate of 20% (9/45) was observed among patients with tumors > 10 cm and pretreatment serum albumin level </= 35 g/L. The overall 1-year, 3-year, and 5-year survival rates from the time of first TACE treatment were 49%, 23%, and 17% respectively. Tumor size </= 10 cm and serum albumin level > 35 g/L were independent favorable prognostic factors. TACE in patients with postresection recurrent HCC was associated with less morbidity, mortality, and a better survival outcome compared with patients with primary inoperable HCC, but this was largely related to smaller tumor size and better liver function in the former group at the time of TACE treatment.


CONCLUSIONS
TACE in patients with inoperable HCC was associated with significant morbidity and mortality, and the survival benefit was limited. Better patient selection in terms of tumor size and liver function may improve treatment results. Patients who have a tumor > 10 cm and poor liver function (serum albumin </= 35 g/L) may not be suitable candidates for TACE treatment.
Poon
R T
RT
Centre of Liver Diseases, Department of Surgery and Diagnostic Radiology, The University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
Ngan
H
H
Lo
C M
CM
Liu
C L
CL
Fan
S T
ST
Wong
J
J
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006499:Hepatic Artery; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011379:Prognosis; D015996:Survival Rate