title: Comparison of transarterial chemoembolization and percutaneous acetic acid injection as the primary loco-regional therapy for unresectable hepatocellular carcinoma: a prospective survey.
abstract: BACKGROUND
  Transarterial chemoembolization (TACE) and percutaneous acetic acid injection (PAI) are effective loco-regional therapies for hepatocellular carcinoma (HCC).
  
  
  OBJECTIVE
  To compare the therapeutic efficacy of TACE vs. PAI for unresectable HCC.
  
  
  METHODS
  A total of 310 patients with unresectable HCCs (size <or=6 cm) undergoing TACE (n = 195) or PAI (n = 115) were studied prospectively. Overall and progression-free survivals were measured endpoints.
  
  
  RESULTS
  The overall survival was not significantly different between the two groups (P = 0.508). Among 129 patients with large (3.1-6 cm) HCCs, the overall survival was significantly better for the TACE group (P = 0.018). Cox multivariate analysis showed that Child-Pugh B [relative risk (RR): 4.2, 95% confidence interval (CI): 2.3-7.7, P < 0.001] and PAI therapy (RR: 1.4, 95%: 1.0-1.9, P = 0.057) were poor prognostic predictors; the progression-free survival was also significantly better in the TACE group (P = 0.038). Among 181 patients with small (<or=3 cm) HCCs, there was no significant difference of overall survival (P = 0.265) or progression-free survival (P = 0.146) between the two groups; Child-Pugh B was the only prognostic factor predicting a decreased survival (RR: 2.8, 95% CI: 1.7-4.8, P < 0.001).
  
  
  CONCLUSIONS
  Patients with large HCC undergoing TACE tend to have a more favourable long-term outcome. For small HCC, either TACE or PAI therapy could be recommended as the primary treatment modality.
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan. tihuo@vghtpe.gov.tw
authors.forename: T
authors.initials: T
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: J-H
authors.initials: JH
authors.lastname: Chiang
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; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D019342:Acetic Acid