title: Modified cisplatin-based transcatheter arterial chemoembolization for large hepatocellular carcinoma: multivariate analysis of predictive factors for tumor response and survival in a 163-patient cohort.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of modified cisplatin-based transcatheter arterial chemoembolization for inoperable hepatocellular carcinomas (HCCs) larger than 5 cm in diameter, and the factors associated with tumor response and survival.
  
  
  METHODS
  From January 2007 to November 2009, 163 patients who underwent modified cisplatin-based chemoembolization for inoperable large HCCs were evaluated. Predominant tumors were as large as 25 cm (median, 8.6 cm). Seventy-nine patients had a solitary tumor, and 84 had two or more tumors. Tumor response was evaluated per modified Response Evaluation Criteria In Solid Tumors.
  
  
  RESULTS
  After chemoembolization, 65% of patients showed a tumor response. On multivariate analysis, tumor size (P < .001) and portal vein (PV) invasion (P = .017) were significant factors for tumor response. After chemoembolization, 97% of patients (56 of 58) with PV invasion received additional radiation therapy for PV tumor thrombosis. Median survival time was 15.8 months. On multivariate analysis, Child-Pugh class (P = .001), surgical resection (P = .003) or radiofrequency (RF) ablation (P = .018) after chemoembolization, and tumor response (P = .002) were significant factors for patient survival after chemoembolization. Major complications (N = 5) included acute renal failure (n = 3), cholecystitis with hepatic abscess (n = 1), and intractable pleural effusion (n = 1).
  
  
  CONCLUSIONS
  Transcatheter arterial chemoembolization is safe and effective for large HCCs. Tumor size and PV invasion are significant predictors of tumor response and, Child-Pugh class A disease, surgical resection after chemoembolization, RF ablation after chemoembolization, and tumor response are good prognostic factors for survival.
authors: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea.
authors: Hee Mang
authors: HM
authors: Yoon
authors: Jin Hyoung
authors: JH
authors: Kim
authors: Eun-Joung
authors: EJ
authors: Kim
authors: Dong Il
authors: DI
authors: Gwon
authors: Gi-Young
authors: GY
authors: Ko
authors: Heung Kyu
authors: HK
authors: Ko
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009378:Neoplasms, Multiple Primary / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016017:Odds Ratio; D011169:Portal Vein / Q000473:pathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: AFP; BCLC; Barcelona Clinic Liver Cancer; HCC; HR; PV; RF; RT; hazard ratio; hepatocellular carcinoma; portal vein; radiation therapy; radiofrequency; α-fetoprotein