Hepatic arterial embolization for unresectable hepatocellular carcinomas: do technical factors affect prognosis?
OBJECTIVE
To evaluate retrospectively whether technical factors of hepatic arterial embolization affect the prognosis of patients with hepatocellular carcinoma (HCC).


METHODS
Inclusion criteria of this study were the following: (1) patients received embolization as the initial treatment during 2003-2004, (2) Child A or B liver profile, (3) five or fewer HCCs with maximum diameter of 7 cm or smaller, and (4) no extrahepatic metastasis. Patient data were gathered from 43 centers. Prognostic factors were evaluated using univariate and multivariate analyses.


RESULTS
Eight hundred fifteen patients were enrolled. The 1-, 3-, 5-, and 7-year overall survival rates were 92.0 % (95 % CI 90.1-93.9), 62.9 % (95 % CI 59.3-66.6), 39.0 % (95 % CI 35.1-43.0), and 26.7 % (95 % CI 22.6-30.8) in all patients. Univariate analysis showed a Child-Pugh class-A, alpha-fetoprotein level lower than 100 ng/ml, tumor size of 3 cm or smaller, tumor number of 3 or fewer, one-lobe tumor distribution, nodular tumor type, within the Milan criteria, stage I or II, no portal venous invasion, use of iodized oil, and selective embolization were significantly better prognostic factors. In the multivariate Cox model, the benefit to survival of selective embolization remained significant (hazard ratio 0.68; 95 % CI 0.48-0.97; p = 0.033).


CONCLUSIONS
Selective embolization contributes to survival in patients with HCCs.
Department of Interventional Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan. yama@clin.medic.mie-u.ac.jp
Koichiro
K
Yamakado
Shiro
S
Miyayama
Shozo
S
Hirota
Kimiyoshi
K
Mizunuma
Kenji
K
Nakamura
Yoshitaka
Y
Inaba
Akihiro
A
Maeda
Kunihiro
K
Matsuo
Norifumi
N
Nishida
Takeshi
T
Aramaki
Hiroshi
H
Anai
Shinichi
S
Koura
Shigeo
S
Oikawa
Ken
K
Watanabe
Taku
T
Yasumoto
Kinya
K
Furuichi
Masato
M
Yamaguchi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000032:analysis
D000509:alpha-Fetoproteins; D007459:Iodized Oil