title: The role of transcatheter arterial embolization for patients with unresectable hepatocellular carcinoma: a nationwide, multicentre study evaluated by cancer stage.
abstract: BACKGROUND
  Transcatheter arterial embolization is a major palliative treatment for unresectable hepatocellular carcinoma, but the survival benefit of transcatheter arterial embolization is controversial.
  
  
  OBJECTIVE
  To evaluate the role of transcatheter arterial embolization in different stage of unresectable hepatocellular carcinoma and to select patients who can get the best benefit from the treatment.
  
  
  METHODS
  From 1991 to 1995, 476 patients who had unresectable hepatocellular carcinoma from four medical centres in Taiwan were enrolled. Among them, 425 underwent transcatheter arterial embolization, and 51 received supportive treatment alone. The survivals between the two groups were compared.
  
  
  RESULTS
  Among the 476 patients, transcatheter arterial embolization can significantly prolong survival. The 1-, 2-, and 5-year survival rates for patients who underwent transcatheter arterial embolization were 60.2%, 39.3%, and 11.5%; and the rates for patients who underwent supportive treatment were 37.3%, 17.6%, and 2%, respectively (P = 0.0002). The survival benefit of transcatheter arterial embolization was observed in patients between Cancer and the Liver Italian Program 0 and Cancer and the Liver Italian Program 4. In multivariate analysis, transcatheter arterial embolization, tumour size <5 cm and earlier Cancer and the Liver Italian Program stage were independent factors associated with a better survival.
  
  
  CONCLUSIONS
  For patients who fulfilled the criteria of transcatheter arterial embolization, embolization can serve as a primary treatment for patients with unresectable hepatocellular carcinoma. The survival benefit of transcatheter arterial embolization is regardless of tumour stages.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan.
authors.forename: Y-H
authors.initials: YH
authors.lastname: Huang
authors.forename: C-H
authors.initials: CH
authors.lastname: Chen
authors.forename: T-T
authors.initials: TT
authors.lastname: Chang
authors.forename: S-C
authors.initials: SC
authors.lastname: Chen
authors.forename: J-H
authors.initials: JH
authors.lastname: Chiang
authors.forename: H-S
authors.initials: HS
authors.lastname: Lee
authors.forename: P-W
authors.initials: PW
authors.lastname: Lin
authors.forename: G-T
authors.initials: GT
authors.lastname: Huang
authors.forename: J-C
authors.initials: JC
authors.lastname: Sheu
authors.forename: H-M
authors.initials: HM
authors.lastname: Tsai
authors.forename: P-C
authors.initials: PC
authors.lastname: Lee
authors.forename: T-I
authors.initials: TI
authors.lastname: Huo
authors.forename: S-D
authors.initials: SD
authors.lastname: Lee
authors.forename: J-C
authors.initials: JC
authors.lastname: Wu
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D002404:Catheterization / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016019:Survival Analysis; D016896:Treatment Outcome