title: Long-term survival of Taiwanese patients with hepatocellular carcinoma after combination therapy with transcatheter arterial chemoembolization and percutaneous ethanol injection.
abstract: OBJECTIVE
  Several studies have shown a superior effect of combination therapy with transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) compared with either monotherapy for the treatment of advanced hepatocellular carcinoma (HCC), but there have been no reports on combination treatment from Taiwan. This study investigated the long-term survival and prognostic factors of HCC patients treated with TACE/PEI combination therapy.
  
  
  METHODS
  A total of 153 consecutive HCC patients, with tumor sizes between 2 and 3 cm in 47 patients, between 3 and 5 cm in 66 patients, and between 5 and 13 cm in 40 patients, who received TACE/PEI combination therapy were included in this retrospective study. The mean follow-up duration was 23 +/- 17 months (range, 1 to 78 months).
  
  
  RESULTS
  The 1-, 2-, 3-, 4-, 5-, and 6-year cumulative survival rates for the patients were 78%, 54%, 40%, 22%, 12%, and 5%, respectively. Multivariate analysis using Cox's proportional hazards model showed that the stage of cirrhosis (Child's class B or C vs class A) was the only factor that significantly affected the survival rate (p = 0.02) [relative risk, 2.10; 95% confidence interval, 1.12 to 3.96]. Univariate analysis showed that survival was poorer in patients with tumors greater than 5 cm than in patients with tumors 2 to 5 cm in largest dimension; this difference was not significant in the multivariate analysis. No serious complications were observed during or after treatment.
  
  
  CONCLUSIONS
  TACE combined with PEI is an alternative treatment for patients with larger HCC who are not suitable for surgical resection. A superior outcome can be expected in patients with Child's class A cirrhosis.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Taipei Municipal Jen-Ai Hospital, Taipei, Taiwan.
authors.forename: Yu-Hsien
authors.initials: YH
authors.lastname: Li
authors.forename: Chaur-Shine
authors.initials: CS
authors.lastname: Wang
authors.forename: Li-Ying
authors.initials: LY
authors.lastname: Liao
authors.forename: Chung-Kwe
authors.initials: CK
authors.lastname: Wang
authors.forename: Li-Shun
authors.initials: LS
authors.lastname: Shih
authors.forename: Ran-Chou
authors.initials: RC
authors.lastname: Chen
authors.forename: Pao-Huei
authors.initials: PH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000477:Alkylating Agents; D000970:Antineoplastic Agents; D000431:Ethanol; D016685:Mitomycin; D004317:Doxorubicin