title: Segmental transcatheter arterial chemoembolization treatment in patients with cirrhosis and inoperable hepatocellular carcinomas.
abstract: OBJECTIVE
  To establish whether segmental transcatheter arterial chemoembolization (TACE) treatment may improve the rates of survival in patients with compensated cirrhosis and inoperable hepatocellular carcinoma (HCC).
  
  
  METHODS
  Fifty-six patients with compensated cirrhosis and inoperable HCC were treated with segmental TACE. One hundred forty treatments (mean, 2.5 per patient; 30-60 mg Epirubicin, 4-10 mL Lipiodol, and Gelfoam particles) were administered.
  
  
  RESULTS
  During the 69-month study, 25 patients (45%) died of tumor progression, 12 (21%) of liver failure, nine (16%) of gastrointestinal hemorrhage, and three (5%) of other causes; seven patients (13%) are still alive. The 3-year rate of survival was 32%. Intention-to-treat analysis determined that patients with Child-Pugh class A disease (n = 44; 79%) or a single <5-cm HCC (n = 21; 37%) had a higher rate of survival than those with Child-Pugh class B disease (n = 12; 21%; P <.002) or a larger HCC (n = 35; 63%; P <.02) and patients (n = 41) who were treated with more than one course of TACE had a higher rate of survival than those who were treated with a single TACE procedure (n = 15; P <.0003). Multivariate analysis was used to predict rates of survival by number of treatments (hazard ratio, 0.6; CI, 0.48-0.86; P <.004), Child-Pugh class (hazard ratio, 2.8; CI, 1.41-5.74; P <.003), and tumor size (hazard ratio, 3.8; CI, 1.81-8.01; P <.001). The 3-year rate of survival in patients with Child-Pugh class A disease and a < or =5-cm-HCC (n = 16) was 56%. This result was similar to the 50% 3-year rate of survival in untreated historic controls with similar characteristics.
  
  
  CONCLUSIONS
  The rate of survival in patients with compensated cirrhosis and inoperable HCC did not appear to improve with use of TACE therapy.
authors.affiliation: Institute of Radiology, IRCCS Maggiore Hospital, University of Milan, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Saccheri
authors.forename: Andrea
authors.initials: A
authors.lastname: Lovaria
authors.forename: Angelo
authors.initials: A
authors.lastname: Sangiovanni
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolini
authors.forename: Cristina
authors.initials: C
authors.lastname: De Fazio
authors.forename: Guido
authors.initials: G
authors.lastname: Ronchi
authors.forename: Pierangelo
authors.initials: P
authors.lastname: Fasani
authors.forename: Ersilio
authors.initials: E
authors.lastname: Del Ninno
authors.forename: Massimo
authors.initials: M
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005781:Gelatin Sponge, Absorbable; D006499:Hepatic Artery; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015996:Survival Rate
chemical_list: D000903:Antibiotics, Antineoplastic; D015251:Epirubicin; D007459:Iodized Oil