title: Induction of complete tumor necrosis may reduce intrahepatic metastasis and prolong survival in patients with hepatocellular carcinoma undergoing locoregional therapy: a prospective study.
abstract: BACKGROUND
  Transarterial chemoembolization (TACE) and percutaneous acetic acid injection (PAI) are effective locoregional therapies for hepatocellular carcinoma (HCC). This study aimed to investigate whether HCC patients who had initial complete response to these treatments had a subsequent lower risk of intrahepatic metastasis.
  
  
  METHODS
  A total of 152 patients who underwent locoregional therapy (94 received PAI and 58 received both TACE and PAI) for HCC (tumor size < or =5 cm) were prospectively evaluated.
  
  
  RESULTS
  In all, 60 (39%) patients had a complete tumor necrosis after treatment. The cumulative incidence of the development of intrahepatic metastasis was lower for patients with complete remission (P = 0.005) and for patients with smaller (< or =3 cm) tumor size (P = 0.083). Cox multivariate survival analysis showed that absence of complete remission [relative risk (RR) 2.7; 95% confidence interval (CI) 1.4-5.3; P = 0.003] was the only independent factor that predicted the occurrence of intrahepatic metastasis. Patients with complete remission had a significantly better long-term survival than those without (P = 0.002), and the occurrence of intrahepatic metastasis over time independently predicted a decreased survival (RR 3.2; 95% CI 2.0-6.1; P = 0.019).
  
  
  CONCLUSIONS
  Induction of complete tumor necrosis in HCC patients undergoing locoregional therapy may decrease the risk of intrahepatic metastasis and improve survival.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. tihuo@vghtpe.gov.tw
authors.forename: T-I
authors.initials: TI
authors.lastname: Huo
authors.forename: Y-H
authors.initials: YH
authors.lastname: Huang
authors.forename: J-C
authors.initials: JC
authors.lastname: Wu
authors.forename: P-C
authors.initials: PC
authors.lastname: Lee
authors.forename: F-Y
authors.initials: FY
authors.lastname: Chang
authors.forename: S-D
authors.initials: SD
authors.lastname: Lee
mesh_terms: D019342:Acetic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D007202:Indicators and Reagents / Q000008:administration & dosage / Q000627:therapeutic use*; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis; D008113:Liver Neoplasms / Q000517:prevention & control / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid