title: Long-term survival of patients with unresectable hepatocellular carcinoma treated with transcatheter arterial chemoinfusion.
abstract: BACKGROUND
  Transcatheter arterial chemoembolization (TACE) has become one of the most common treatments for unresectable hepatocellular carcinoma. Published studies of TACE report a 5-16% risk of serious complications. Compared with TACE, transcatheter arterial chemoinfusion (TACI) may have similar efficacy and fewer side effects.
  
  
  OBJECTIVE
  To examine the clinical outcomes of TACI.
  
  
  METHODS
  We performed a retrospective cohort study of 345 consecutive TACI cases in 165 patients performed at a single United States medical center between 1998 and 2002. Primary outcomes were tumour response and survival rates.
  
  
  RESULTS
  Only seven patients were hospitalized for more than 24 h after the procedure, and only three patients had worsening of liver function within 30 days of TACI. Survival was significantly poorer for patients with tumour-node-metastasis (TNM) IV compared to those with TNM I-III and also for patients with Child's class B/C vs. A. Following adjustment for age, gender, ethnicity and aetiology of liver diseases, independent predictors of poor survival were Child's class B/C [Hazard Ratio (HR) = 1.69, P = 0.024] and TNM IV staging (HR = 1.63, P = 0.014).
  
  
  CONCLUSIONS
  TACI appears to be safe and effective for unresectable hepatocellular carcinoma with TNM stage I-III; randomized controlled trials are needed to compare TACI to TACE.
authors.affiliation: Division of GI and Hepatology, Stanford University School of Medicine, Stanford, CA 94304-1509, USA.
authors.forename: B Y
authors.initials: BY
authors.lastname: Ha
authors.forename: A
authors.initials: A
authors.lastname: Ahmed
authors.forename: D Y
authors.initials: DY
authors.lastname: Sze
authors.forename: M K
authors.initials: MK
authors.lastname: Razavi
authors.forename: N
authors.initials: N
authors.lastname: Simpson
authors.forename: E B
authors.initials: EB
authors.lastname: Keeffe
authors.forename: M H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States