Transcatheter arterial chemoembolisation for hepatocellular carcinoma in cirrhosis: survival rate and prognostic factors.
BACKGROUND
The role of prognostic variables in the treatment of hepatocellular carcinoma (HCC) by transarterial chemoembolisation (TACE) is controversial.


OBJECTIVE
To evaluate the survival of patients with HCC on cirrhosis treated with TACE and to analyse the prognostic factors affecting survival.


METHODS
From 1996 to 2006, 580 consecutive patients with HCC in cirrhosis were observed. Of these 194 patients underwent TACE. The primary end-point was survival. Independent predictors of survival were identified using the Cox model.


RESULTS
The cumulative 1-year, 3-year, and 5-year survival rates were 96%, 60%, and 41%, respectively. The multivariate analysis showed significant reduction of survival among patients with serum bilirubin values >2mg/dl compared to patients with values <2mg/dl (Hazard ratio 3.84; CI 95% 1.70-8.66; p-value=0.001). Multivariate analysis performed in the group of patients treated with TACE alone showed that elevated serum bilirubin (Hazard ratio 2.96; CI 95% 1.20-7.3; p-value 0.02) and incomplete tumour response (Hazard ratio 2.88; CI 95% 1.18-7.05; p-value 0.02) are correlated with a worse outcome.


CONCLUSIONS
TACE was well tolerated and overall survival rate was 41% after 5 years. Complete tumour response and serum bilirubin <2mg/dl were identified as predictors of survival.
Olivo
Mirko
M
Medicine, Pneumatology and Nutrition Physiology Clinic, V. Cervello Hospital, Palermo University, Italy. mirko.olivo@libero.it
Valenza
Franco
F
Buccellato
Antonio
A
Scala
Lorenza
L
Virdone
Roberto
R
Sciarrino
Elio
E
Di Piazza
Sonia
S
Marrone
Ciro
C
Orlando
Ambrogio
A
Fusco
Giorgio
G
Madonia
Salvatore
S
Cottone
Mario
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D015331:Cohort Studies; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage; D006499:Hepatic Artery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D016016:Proportional Hazards Models
D000903:Antibiotics, Antineoplastic; D006490:Hemostatics; D015251:Epirubicin