title: Transarterial chemoembolization vs. conservative treatment for unresectable infiltrating hepatocellular carcinoma: A retrospective comparative study.
abstract: This study was conducted to compare long-term survival between patients with unresectable infiltrating hepatocellular carcinoma (HCC) who were treated with transarterial chemoembolization (TACE) and those who received conservative treatment (best supportive care). Between January, 2007 and January, 2012, a total of 131 consecutive patients with unresectable infiltrating HCC underwent TACE in a cancer center (TACE group), while 156 similar consecutive HCC patients received conservative treatment in another cancer center (conservative treatment group). The diagnosis of unresectable infiltrating HCC was established by agreement between two radiologists coming from the two centers, who performed an independent review of all the cross-sectional imagings of the patients. The two groups were comparable regarding patient characteristics, preoperative liver function, tumor burden and general condition. In the TACE group, 52 patients received one session and 79 patients received more than one session of TACE (mean, 1.5 and range, 1-4 sessions). There was no reported TACE-related mortality. The 1-month mortality rate was 0.8 and 3.8% in the TACE and the conservative groups, respectively (P=0.134). The median survival for the TACE and conservative treatment groups was 7.0 and 3.0 months, respectively. The 6-, 12- and 24-month overall survival rates for the TACE and conservative treatment groups were 61.7, 18.5 and 2.3% vs. 22.7, 12.1 and 0%, respectively (P<0.001). On multivariate analysis, treatment allocation [odds ratio (OR)=1.777; 95% confidence interval (CI): 1.499-2.107; P<0.001] and portal vein tumor thrombosis (OR=1.721; 95% CI: 1.504-1.907; P<0.001) were independent predictors of overall survival. In conclusion, TACE was found to be a safe and feasible treatment option for patients with unresectable infiltrating HCC and it conferred survival benefit over conservative treatment.
authors.affiliation: Department of Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, SAR, P.R. China.
authors.forename: Qiang-Sheng
authors.initials: QS
authors.lastname: Dai
authors.affiliation: Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, SAR, P.R. China.
authors.forename: Hong-Lin
authors.initials: HL
authors.lastname: Gu
authors.affiliation: Department of Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, SAR, P.R. China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Ye
authors.affiliation: State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, SAR, P.R. China ; Department of Hepatobiliary Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, SAR, P.R. China.
authors.forename: Yao-Jun
authors.initials: YJ
authors.lastname: Zhang
authors.affiliation: State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, SAR, P.R. China ; Department of Hepatobiliary Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, SAR, P.R. China.
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Lin
authors.affiliation: Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR, P.R. China.
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
authors.affiliation: Department of Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, SAR, P.R. China.
authors.forename: Zhen-Wei
authors.initials: ZW
authors.lastname: Peng
authors.affiliation: State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, SAR, P.R. China ; Department of Hepatobiliary Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, SAR, P.R. China.
authors.forename: Min-Shan
authors.initials: MS
authors.lastname: Chen
keywords: conservative treatment; independent predictor; survival; transarterial chemoembolization; unresectable infiltrating hepatocellular carcinoma