title: Hepatocellular carcinoma treated by conventional transarterial chemoembolization in field-practice: serum sodium predicts survival.
abstract: OBJECTIVE
  To assess the prognostic role of baseline clinical, biochemical and radiological characteristics of patients with hepatocellular carcinoma (HCC) treated with the first transarterial chemoembolization (TACE) procedure.
  
  
  METHODS
  Patients with HCC treated with conventional TACE in a tertiary care setting from 1997 to 2008 were retrospectively reviewed. Predictors of survival were identified using the Cox proportional regression model.
  
  
  RESULTS
  Two hundred and seventy patients were included. Median age was 66 years, 81% were male, 58% were HCV-positive, 18% hepatitis B surface antigen-positive, 64% had a Child A status, 40% patients had a largest nodule diameter ≥ 5 cm and 32% had more than 3 tumor nodules. Median overall survival of the whole cohort was 25 mo (95%CI: 21.8-28.2) and the 1-, 2- and 3-year probability of survival was 80%, 50% and 31%, respectively. Non-tumor segmental portal vein thrombosis (HR = 1.76, 95%CI: 1.22-2.54), serum sodium (HR = 1.65, 95%CI: 1.25-2.18), diameter of largest nodule (HR = 1.59, 95%CI: 1.22-2.091), number of nodules (HR = 1.41, 95%CI: 1.06-1.88), alpha-fetoprotein (HR = 1.35, 95%CI: 1.03-1.76) and alkaline phosphatase (HR = 1.33, 95%CI: 1.01-1.74) were independent prognostic factors for overall survival on multivariate analysis.
  
  
  CONCLUSIONS
  The inclusion of serum sodium alongside the already known prognostic factors may allow a better prognostic definition of patients with HCC as candidates for conventional TACE.
authors.affiliation: Marco Biolato, Luca Miele, Vittoria Vero, Simona Racco, Andrea Zanché, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Gasbarrini, Antonio Grieco, Department of Internal Medicine, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Biolato
authors.affiliation: Marco Biolato, Luca Miele, Vittoria Vero, Simona Racco, Andrea Zanché, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Gasbarrini, Antonio Grieco, Department of Internal Medicine, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Miele
authors.affiliation: Marco Biolato, Luca Miele, Vittoria Vero, Simona Racco, Andrea Zanché, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Gasbarrini, Antonio Grieco, Department of Internal Medicine, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Vero
authors.affiliation: Marco Biolato, Luca Miele, Vittoria Vero, Simona Racco, Andrea Zanché, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Gasbarrini, Antonio Grieco, Department of Internal Medicine, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Racco
authors.affiliation: Marco Biolato, Luca Miele, Vittoria Vero, Simona Racco, Andrea Zanché, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Gasbarrini, Antonio Grieco, Department of Internal Medicine, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Di Stasi
authors.affiliation: Marco Biolato, Luca Miele, Vittoria Vero, Simona Racco, Andrea Zanché, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Gasbarrini, Antonio Grieco, Department of Internal Medicine, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Iezzi
authors.affiliation: Marco Biolato, Luca Miele, Vittoria Vero, Simona Racco, Andrea Zanché, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Gasbarrini, Antonio Grieco, Department of Internal Medicine, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Zanché
authors.affiliation: Marco Biolato, Luca Miele, Vittoria Vero, Simona Racco, Andrea Zanché, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Gasbarrini, Antonio Grieco, Department of Internal Medicine, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pompili
authors.affiliation: Marco Biolato, Luca Miele, Vittoria Vero, Simona Racco, Andrea Zanché, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Gasbarrini, Antonio Grieco, Department of Internal Medicine, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Gian Ludovico
authors.initials: GL
authors.lastname: Rapaccini
authors.affiliation: Marco Biolato, Luca Miele, Vittoria Vero, Simona Racco, Andrea Zanché, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Gasbarrini, Antonio Grieco, Department of Internal Medicine, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: La Torre
authors.affiliation: Marco Biolato, Luca Miele, Vittoria Vero, Simona Racco, Andrea Zanché, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Gasbarrini, Antonio Grieco, Department of Internal Medicine, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.affiliation: Marco Biolato, Luca Miele, Vittoria Vero, Simona Racco, Andrea Zanché, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Gasbarrini, Antonio Grieco, Department of Internal Medicine, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, 00168 Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Grieco
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012964:Sodium / Q000097:blood*; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins; D012964:Sodium; D000469:Alkaline Phosphatase
keywords: Chemoembolization; Hyponatremia; Liver cancer; Model for end-stage liver disease sodium; Sorafenib