title: Comparative study of cisplatin and epirubicin in transcatheter arterial chemoembolization for hepatocellular carcinoma.
abstract: OBJECTIVE
  Transcatheter arterial chemoembolization (TACE) is an established treatment for unresectable hepatocellular carcinoma (HCC). However, it is unclear which chemotherapeutic agent should be selected for TACE. The aim of this study was to compare the efficacy of cisplatin (CDDP) with that of epirubicin (EPI) in TACE for patients with unresectable or relapsed HCC.
  
  
  METHODS
  We performed a historical cohort study involving 131 patients treated with a first TACE, defined as either an initial treatment for previously untreated HCC or a first treatment for relapsed HCC after curative resections or ablations. Efficacy was estimated as the response rate (RR) and it was adjusted for the confounding factors that were defined in this study.
  
  
  RESULTS
  The RR were 62.5% (20/32) for the first TACE with CDDP and 51.5% (51/99) for that with EPI. In the adjusted analysis for a history of hepatectomy, percutaneous treatment combined with TACE and tumor factors, the odds ratio was 1.72 (95% confidence interval [CI] = 0.70-4.48). However, a test for interaction between the number of tumors and the chemotherapeutic agent was statistically significant (P = 0.016). In multiple HCC, the RR were 66.7% (10/17) for CDDP and 39.6% (30/46) for EPI. The odds ratio was 4.11 (95% CI = 1.14-17.2).
  
  
  CONCLUSIONS
  CDDP may be more effective than EPI in TACE for multiple HCC. A randomized controlled study is needed to clarify the efficacy of CDDP in TACE in patients with multiple HCC.
authors.affiliation: Departments of SurgeryDiagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto UniversityDepartment of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Etsuro
authors.initials: E
authors.lastname: Hatano
authors.forename: Masato
authors.initials: M
authors.lastname: Narita
authors.forename: Kojiro
authors.initials: K
authors.lastname: Taura
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yasuchika
authors.forename: Takashi
authors.initials: T
authors.lastname: Nitta
authors.forename: Shigeki
authors.initials: S
authors.lastname: Arizono
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Isoda
authors.forename: Toshiya
authors.initials: T
authors.lastname: Shibata
authors.forename: Iwao
authors.initials: I
authors.lastname: Ikai
authors.forename: Tosiya
authors.initials: T
authors.lastname: Sato
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto