title: Long-term outcomes of second treatment after initial transarterial chemoembolization in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  All outcome studies concerning the management of hepatocellular carcinoma (HCC) are based on the initial treatment. However, remaining, progressing or recurring tumours (RPRTs) after transarterial chemoembolization (TACE) are common; therefore, various second treatments are administered to HCC patients. Here, we investigated the long-term outcomes of second treatments for RPRT after initial TACE.
  
  
  METHODS
  We enrolled 855 consecutive HCC patients who underwent TACE as the initial treatment at the National Cancer Center, Korea, from January 2004 to December 2010.
  
  
  RESULTS
  The median follow-up was 43.4 months, and the median progression-free survival following initial TACE was 4.0 months, being 18.1 and 1.0 months for complete remission and progressive disease respectively. Second treatments were administered to 790 RPRT patients (92.4%); the most common was TACE (56.4%), followed by best supportive care (22.8%), systemic chemotherapy (9.4%), external radiotherapy (4.4%), radiation ablation (RFA; 2.9%), resection (2.0%) and liver transplantation (1.4%). Median overall survival (mOS) for initial TACE was 18.8 months [95% confidence interval (CI), 16.6-21.0 months]; after second treatments, it was 12.4 (95% CI, 10.6-14.2) months, differing significantly by mRECIST assessment, BCLC stage and RPRT type (28.0, 5.0 and 3.9 months for intrahepatic, vascular and extrahepatic RPRT, respectively; P < 0.001). Intrahepatic RPRT with a curative treatment as a second treatment showed the best OS.
  
  
  CONCLUSIONS
  These novel insights into the patterns and long-term outcomes of second treatments for RPRT in HCC patients who underwent initial TACE are expected to aid in formulating treatment strategies for HCC patients.
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Young-Il
authors.initials: YI
authors.lastname: Kim
authors.forename: Joong-Won
authors.initials: JW
authors.lastname: Park
authors.forename: Hee-Won
authors.initials: HW
authors.lastname: Kwak
authors.forename: Bo Hyun
authors.initials: BH
authors.lastname: Kim
authors.forename: Ju Hee
authors.initials: JH
authors.lastname: Lee
authors.forename: In Joon
authors.initials: IJ
authors.lastname: Lee
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.forename: Seong Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Young Hwan
authors.initials: YH
authors.lastname: Koh
authors.forename: Hyun Beom
authors.initials: HB
authors.lastname: Kim
authors.forename: Chang-Min
authors.initials: CM
authors.lastname: Kim
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage*; D006499:Hepatic Artery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D011446:Prospective Studies; D056910:Republic of Korea; D016896:Treatment Outcome
chemical_list: D004317:Doxorubicin
keywords: TACE; hepatocellular carcinoma; outcome; second treatment