title: Impact of cytolysis following transarterial chemoembolization for hepatocellular carcinoma.
abstract: OBJECTIVE
  Transarterial chemoembolization (TACE) is increasingly used as a treatment of hepatocellular carcinoma. Cytolysis, which may occur within days following the procedure is due to either necrosis of the tumour or of the non-tumoral parenchyma. Therefore it may influence either tumour response or liver function or both. We evaluated the impact of cytolysis after TACE on tumour response, incidence of hepatobiliary complications and overall survival.
  
  
  METHODS
  We conducted a retrospective analysis of 157 patients with liver disease who underwent 271 treatments for hepatocellular carcinoma. Cytolysis was defined as an increase of AST value above 100 IU/L with at least doubling of the baseline value. The associations between cytolysis and radiologic tumor response two months following each treatment and adverse hepatobiliary events were estimated using generalized estimating equations models. Comparison of 18 months survival after a first treatment of chemoembolization between the groups with and without cytolysis was performed using the proportional hazards model.
  
  
  RESULTS
  Cytolysis occurred in 198 out of 271 cases and was associated with a favourable radiological response (OR 1.90, 1.03-3.54) at two months compared to non-cytolysis with no difference in the occurrence of adverse hepatobiliary events. The adjusted hazard ratio for overall survival was 1.33 times greater in the group with cytolysis compared to non-cytolysis (0.45-3.90).
  
  
  CONCLUSIONS
  The occurrence of cytolysis was associated with a favorable radiological response, but had no impact on short-term adverse events and on survival at 18 months.
authors: Department of gastroenterology, CHUQ, Université Laval, Québec, Canada;
authors: Vladimir
authors: V
authors: Marquez
authors: Marie-Pierre
authors: MP
authors: Sylvestre
authors: Claire
authors: C
authors: Wartelle-Bladou
authors: Louis
authors: L
authors: Bouchard
authors: Pierre
authors: P
authors: Perrault
authors: Philippe
authors: P
authors: Grégoire
authors: Gilles
authors: G
authors: Pomier-Layrargues
keywords: Cytolysis; cohort; hepatocellular carcinoma; transarterial chemoembolization