title: Predictors of repeat transarterial chemoembolization in the treatment of hepatocellular carcinoma.
abstract: OBJECTIVE
  Repeat transarterial chemoembolization (TACE) is a common intervention performed for hepatocellular carcinoma (HCC). The aim of this study was to identify predictors of the need for repeat TACE.
  
  
  METHODS
  Between 2008 and 2012, data on patient and tumour variables were collected for 262 patients treated with a first TACE procedure for HCC. The decision to perform repeat TACE procedures was made at the completion of the first TACE or after follow-up imaging demonstrated the subtotal treatment of HCC tumours.
  
  
  RESULTS
  Repeat TACE was performed in 67 of 262 (25.6%) patients. Necrosis of HCC, measured after the first TACE, was lower in patients who subsequently received repeat TACE (P = 0.042). On multivariable analysis, total tumour diameter of >5 cm [odds ratio (OR) 2.76, 95% confidence interval (CI) 1.45-5.25; P = 0.002] and increasing age (OR 1.04/year, 95% CI 1.00-1.07; P = 0.030) were predictive of the need for repeat TACE. Measures of liver function and TACE approach (selective versus non-selective) were not predictive of repeat TACE. Median survival did not differ significantly between patients who did (median survival: 21.1 months) and did not (median survival: 26.1 months) receive a repeat TACE procedure (P = 0.574).
  
  
  CONCLUSIONS
  The requirement for repeat TACE is associated with older age, increased HCC tumour burden and subtotal TACE-induced HCC necrosis. Importantly, repeat TACE was not associated with reduced survival.
authors.affiliation: Department of Liver Transplant and Hepatobiliary Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Jared A
authors.initials: JA
authors.lastname: White
authors.forename: David T
authors.initials: DT
authors.lastname: Redden
authors.forename: Mary Kate
authors.initials: MK
authors.lastname: Bryant
authors.forename: David
authors.initials: D
authors.lastname: Dorn
authors.forename: Souheil
authors.initials: S
authors.lastname: Saddekni
authors.forename: Ahmed Kamel
authors.initials: AK
authors.lastname: Abdel Aal
authors.forename: Jessica
authors.initials: J
authors.lastname: Zarzour
authors.forename: David
authors.initials: D
authors.lastname: Bolus
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Smith
authors.forename: Stephen
authors.initials: S
authors.lastname: Gray
authors.forename: Devin E
authors.initials: DE
authors.lastname: Eckhoff
authors.forename: Derek A
authors.initials: DA
authors.lastname: DuBay
mesh_terms: D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis; D016017:Odds Ratio; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden