title: Comparison of transarterial chemoembolization in patients with unresectable, diffuse vs focal hepatocellular carcinoma.
abstract: OBJECTIVE
  Transarterial chemoembolization (TACE) is beneficial for selected patients with unresectable hepatocellular carcinoma (HCC).
  
  
  METHODS
  A prospective comparison study in a tertiary hospital.
  
  
  METHODS
  November 21, 1995, to May 2, 2001, with a mean follow-up of 939 days.
  
  
  METHODS
  A total of 157 TACE treatments were performed in 88 patients with unresectable HCC: 132 treatments in 69 patients with focal HCC (F-HCC) and 25 treatments in 19 patients with diffuse HCC (D-HCC).
  
  
  METHODS
  Transarterial chemoembolization consisted of selective catheterization and intra-arterial infusion of a mixture of doxorubicin hydrochloride, cisplatin, and mitomycin followed by embolization. Sequential treatments were performed for bilobar HCC.
  
  
  METHODS
  Child-Pugh classification and clinical outcomes, including alpha-fetoprotein (AFP) response, length of hospital stay, readmission rate, and survival, were compared between patients with F-HCC and D-HCC following TACE using the chi(2) test, Fisher exact test, or t test (2-tailed, unpaired).
  
  
  RESULTS
  Fifty-eight patients (84%) in the F-HCC group and 18 patients (95%) in the D-HCC group had cirrhosis. For those patients with cirrhosis, 58 (100%) in the F-HCC group and 14 (78%) in the D-HCC group had a Child-Pugh score of A or B (P =.002). The mean baseline AFP was higher in the D-HCC group: 55 577 vs 7815 ng/mL in the F-HCC group (P =.001). Of the patients secreting AFP, 4 (29%) of 14 in the D-HCC group and 30 (68%) of 44 in the F-HCC group had a significant decrease in AFP 1 month following TACE (P =.01). The mean hospital stay was longer (3 vs 1.9 days; P =.001), and readmissions occurred more frequently (44% vs 9%; P<.001) in the D-HCC group. The mean survival rate was significantly higher in the F-HCC group: 425 vs 103 days (P<.001).
  
  
  CONCLUSIONS
  In patients with F-HCC, TACE is well tolerated and provides a survival benefit. However, there is no apparent benefit for patients with D-HCC. Importantly, tumor characteristics and hepatic reserve are essential criteria for successful TACE.
authors.affiliation: Comprehensive Liver Disease Center, St Vincent Medical Center, Los Angeles, CA 90057, USA.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Lopez
authors.forename: Shi-Hui
authors.initials: SH
authors.lastname: Pan
authors.forename: Allen L
authors.initials: AL
authors.lastname: Hoffman
authors.forename: Carlos
authors.initials: C
authors.lastname: Ramirez
authors.forename: Sergio E
authors.initials: SE
authors.lastname: Rojter
authors.forename: Hector
authors.initials: H
authors.lastname: Ramos
authors.forename: Michael
authors.initials: M
authors.lastname: McMonigle
authors.forename: Juan
authors.initials: J
authors.lastname: Lois
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome