title: Safety and efficacy of transcatheter arterial chemoemboliazation in the real-life management of unresectable hepatocellular carcinoma.
abstract: BACKGROUND
  Trans-arterial chemoembolization (TACE) is associated with better survival in BCLC-stage B patients with hepatocellular carcinoma (HCC) and Child-Pugh A whereas in Child-Pugh B there is no definite evidence of benefit.
  
  
  OBJECTIVE
  To assess the safety and efficacy of TACE during routine clinical practice in a consecutive Greek cohort of patients with unrespectable HCC.
  
  
  METHODS
  Seventy one patients enrolled for this study (mean follow-up:24.6 months). 100 mg cisplatin, 50 mg doxorubicin and 10 ml lipiodol as well as embolic materials were used. CT-scans and blood tests were obtained prior and post-TACE. Kaplan-Meier method and Cox proportional hazard model were used to evaluate survival and factors affecting survival.
  
  
  RESULTS
  Survival at 1-year, 2-years, 3-years and 5-years was 73.2%, 45.4%, 33.2% and 14.9% respectively. Procedure-related mortality was 1.4%. Multivariate analysis showed lesion diameter, Child-Pugh classification, alcohol abuse, tumor response and AFP prior TACE as independent prognostic factors of survival. Patients diagnosed during surveillance had significantly better survival rates compared to those diagnosed after development of symptoms (HR = 0.58, 95%CI: 0.33-1.01, P < 0.05).
  
  
  CONCLUSIONS
  TACE is safe and efficient for unrespectable HCC. Alcohol abuse, tumor burden, response criteria, Child-Pugh and AFP prior to the session were identified as independent predictors of survival whereas, adherence to surveillance programs resulted in significantly better survival in these patients.
authors.affiliation: Department of Radiology, Medical School, University Hospital of Larissa, University of Thessaly, Larissa, Greece.
authors.forename: Argyro
authors.initials: A
authors.lastname: Mazioti
authors.forename: Nikolaos K
authors.initials: NK
authors.lastname: Gatselis
authors.forename: Christos
authors.initials: C
authors.lastname: Rountas
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Zachou
authors.forename: Dimitrios K
authors.initials: DK
authors.lastname: Filippiadis
authors.forename: Kostantinos
authors.initials: K
authors.lastname: Tepetes
authors.forename: George K
authors.initials: GK
authors.lastname: Koukoulis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Fezoulidis
authors.forename: George N
authors.initials: GN
authors.lastname: Dalekos
keywords: Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Hepatitis B Virus; Hepatitis C; Liver Cirrhosis