Risk factors for death in 224 cases of hepatocellular carcinoma after transcatheter arterial chemoembolization.
OBJECTIVE
Transcatheter arterial chemoembolization (TACE) has been reported as effective therapy for unresectable hepatocellular carcinoma (HCC), however, few have described methods for predicting prognosis, especially in patients treated by repeated TACE. To determine risk factors for death and try to predict the prognosis, we evaluated clinical data.


METHODS
We retrospectively analyzed the clinical parameters of 224 patients with unresectable HCC treated with repeated TACE from January 1997 to December 2007. TACE was repeated when recurrence was diagnosed by tumor marker elevation and/or dynamic computed tomography findings. Factors affecting survival were evaluated using multivariate analysis after univariate analysis. Next, we combined the score for each significant factor into a single prognostic score and added up the positive factors in each case, then analyzed the significance of prognosis, after which the results were compared with other prognostic scoring systems.


RESULTS
Multivariate analysis revealed that bilobular HCC, alpha-fetoprotein (> or = 400 ng/ml), tumor invasion of the portal vein, tumor size (> or = 10 cm), and albumin (< 2.8 g/dl) were related to poor prognosis, and developed a prognostic scoring system from those. According to that score, patients were classified into 5 groups.


CONCLUSIONS
Our scoring system was easily performed and the results showed that repeated TACE should not be administered to patients with scores of 3 or more.
Hiraoka
Atsushi
A
Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, Japan. hirage@m.ehime-u.ac.jp
Horiike
Norio
N
Yamashita
Yoshimasa
Y
Koizumi
Yohei
Y
Doi
Hirokazu
H
Yamamoto
Yasunori
Y
Ichikawa
Soichiro
S
Hasebe
Aki
A
Yano
Makoto
M
Miyamoto
Yasunao
Y
Ninomiya
Tomoyuki
T
Ootani
Hiromi
H
Takamura
Kazuto
K
Kawasaki
Hideki
H
Otomi
Yoichi
Y
Kogame
Masahiro
M
Sogabe
Ichiro
I
Ishimaru
Yoshihiro
Y
Kashihara
Kenichi
K
Miyagawa
Masao
M
Hirooka
Masashi
M
Hiasa
Yoichi
Y
Matsuura
Bunzo
B
Michitaka
Kojiro
K
Onji
Morikazu
M
D000368:Aged; D000418:Albumins / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D008297:Male; D009361:Neoplasm Invasiveness; D011169:Portal Vein / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D000509:alpha-Fetoproteins / Q000032:analysis
D000418:Albumins; D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins