Transcatheter arterial chemoembolization therapy for patients with hepatocellular carcinoma: a case-controlled study.
OBJECTIVE
Transcatheter arterial chemoembolization (TACE) currently is used as a palliative treatment for patients with unresectable hepatocellular carcinoma (HCC), but its efficacy still is debated. Our aim was to assess the impact of TACE on patient survival and to identify prognostic factors for survival.


METHODS
Fifty-six cirrhotic patients with unresectable HCC undergoing at least 1 course of TACE were matched 1:1 for sex, age (in 5-year periods), parameters of Child-Pugh score, Okuda stage, and tumor type with a control group who had received only supportive care.


RESULTS
The 2 groups were comparable for cause of cirrhosis, alpha-fetoprotein serum levels, and Cancer of the Liver Italian Program (CLIP) score. The 56 patients in the TACE group received a total of 123 treatment courses. The median follow-up period was 16 months (range, 1-67 mo) in the TACE group and 5 months (range, 1-77 mo) in the supportive care group. Survival rates at 12, 24, and 30 months in patients receiving TACE were 74.3%, 52.1%, and 38.8%, respectively, with a median survival time of 25 months, whereas in supportive care patients the rates were 39.4%, 25.4%, and 19%, respectively, with a median survival time of 7 months (P = .0004). At univariate analysis, TACE, tumor type, presence of ascites, alpha-fetoprotein serum level, CLIP score, and Okuda stage were associated significantly with survival. Only TACE and CLIP score proved to be independent predictors of survival at multivariate analysis.


CONCLUSIONS
TACE is an effective therapeutic option for cirrhotic patients with unresectable HCC and a CLIP score of 3 or less.
Biselli
Maurizio
M
Semeiotica Medica, Dipartimento Medicina Interna, Cardioangiologia ed Epatologia, Università di Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Andreone
Pietro
P
Gramenzi
Annagiulia
A
Trevisani
Franco
F
Cursaro
Carmela
C
Rossi
Cristina
C
Ricca Rosellini
Salvatore
S
Cammà
Carlo
C
Lorenzini
Stefania
S
Stefanini
Giuseppe Francesco
GF
Gasbarrini
Giovanni
G
Bernardi
Mauro
M
D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016022:Case-Control Studies; D002423:Cause of Death; D016461:Chemoembolization, Therapeutic; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery; D006801:Humans; D007558:Italy; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D015251:Epirubicin