title: Transcatheter arterial chemoembolisation for hepatocellular carcinoma in cirrhosis: survival rate and prognostic factors.
abstract: 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.
authors.affiliation: Medicine, Pneumatology and Nutrition Physiology Clinic, V. Cervello Hospital, Palermo University, Italy. mirko.olivo@libero.it
authors.forename: Mirko
authors.initials: M
authors.lastname: Olivo
authors.forename: Franco
authors.initials: F
authors.lastname: Valenza
authors.forename: Antonio
authors.initials: A
authors.lastname: Buccellato
authors.forename: Lorenza
authors.initials: L
authors.lastname: Scala
authors.forename: Roberto
authors.initials: R
authors.lastname: Virdone
authors.forename: Elio
authors.initials: E
authors.lastname: Sciarrino
authors.forename: Sonia
authors.initials: S
authors.lastname: Di Piazza
authors.forename: Ciro
authors.initials: C
authors.lastname: Marrone
authors.forename: Ambrogio
authors.initials: A
authors.lastname: Orlando
authors.forename: Giorgio
authors.initials: G
authors.lastname: Fusco
authors.forename: Salvatore
authors.initials: S
authors.lastname: Madonia
authors.forename: Mario
authors.initials: M
authors.lastname: Cottone
mesh_terms: 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
chemical_list: D000903:Antibiotics, Antineoplastic; D006490:Hemostatics; D015251:Epirubicin