title: Predicting survival in patients with hepatocellular carcinoma treated by transarterial chemoembolisation.
abstract: BACKGROUND
  Transarterial chemoembolisation (TACE) is first-line treatment in unresectable hepatocellular carcinoma (HCC) and rescue treatment after failure of radical treatments in early stage HCC. Prognostic tools for HCC using time-fixed Cox models may be unreliable in patients treated with TACE because time-varying predictors interact.
  
  
  OBJECTIVE
  To explore time-dependent variables as survival predictors in patients with HCC receiving TACE as first-line or second-line treatment.
  
  
  METHODS
  Eighty four consecutive patients with HCC (mean age 68; male gender 62%; Child-Pugh class: A n=73, B n=11; Barcelona Clinic Liver Cancer class: A n=44, B n=24, C n=16) treated with TACE were enrolled. Clinical, laboratory and radiological follow-up data were collected from the time of first treatment. Time-fixed and time-dependent Cox analyses were done.
  
  
  RESULTS
  Overall survival rates were 89.6% (95% CI 82.5-97.2) at 12months, 58.8% (95% CI 46.2-74.9) at 24, 35.4% (95% CI 22.3-56.1) at 36 and 17.2% (95% CI 7.0-41.7) at 48months. Performance status (P<0.001), number of nodules (P<0.016) and prior therapy (P=0.017) were the only variables strongly linked to survival by time-fixed Cox model. Performance status (P<0.001), prior therapy (P=0.005), number of treatments (P=0.013), complete response after TACE (P=0.005) and bilirubin level (P<0.001) were associated with survival using a time-dependent Cox model.
  
  
  CONCLUSIONS
  Survival after TACE is influenced most by performance status, complete response and bilirubin. Compared with the time-fixed models, a time-dependent Cox model has the potential to estimate a more precise prognosis in HCC patients treated with TACE.
authors.affiliation: Sezione di Gastroenterologia, DIBIMIS, University of Palermo, Palermo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Cabibbo
authors.forename: C
authors.initials: C
authors.lastname: Genco
authors.forename: V
authors.initials: V
authors.lastname: Di Marco
authors.forename: M
authors.initials: M
authors.lastname: Barbara
authors.forename: M
authors.initials: M
authors.lastname: Enea
authors.forename: P
authors.initials: P
authors.lastname: Parisi
authors.forename: G
authors.initials: G
authors.lastname: Brancatelli
authors.forename: P
authors.initials: P
authors.lastname: Romano
authors.forename: A
authors.initials: A
authors.lastname: Craxì
authors.forename: C
authors.initials: C
authors.lastname: Cammà
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome