Outcome of transarterial chemoembolization-based multi-modal treatment in patients with unresectable hepatocellular carcinoma.
OBJECTIVE
To investigate the efficacy and safety of transarterial chemoembolization (TACE)-based multimodal treatment in patients with large hepatocellular carcinoma (HCC).


METHODS
A total of 146 consecutive patients were included in the analysis, and their medical records and radiological data were reviewed retrospectively.


RESULTS
In total, 119 patients received TACE-based multi-modal treatments, and the remaining 27 received conservative management. Overall survival (P<0.001) and objective tumor response (P=0.003) were significantly better in the treatment group than in the conservative group. After subgroup analysis, survival benefits were observed not only in the multi-modal treatment group compared with the TACE-only group (P=0.002) but also in the surgical treatment group compared with the loco-regional treatment-only group (P<0.001). Multivariate analysis identified tumor stage (P<0.001) and tumor type (P=0.009) as two independent pre-treatment factors for survival. After adjusting for significant pre-treatment prognostic factors, objective response (P<0.001), surgical treatment (P=0.009), and multi-modal treatment (P=0.002) were identified as independent post-treatment prognostic factors.


CONCLUSIONS
TACE-based multi-modal treatments were safe and more beneficial than conservative management. Salvage surgery after successful downstaging resulted in long-term survival in patients with large, unresectable HCC.
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
Do Seon
DS
Song
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
Soon Woo
SW
Nam
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
Si Hyun
SH
Bae
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
Jin Dong
JD
Kim
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
Jeong Won
JW
Jang
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
Myeong Jun
MJ
Song
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
Sung Won
SW
Lee
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
Hee Yeon
HY
Kim
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
Young Joon
YJ
Lee
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
Ho Jong
HJ
Chun
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
Young Kyoung
YK
You
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
Jong Young
JY
Choi
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
Seung Kew
SK
Yoon
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Hepatocellular carcinoma; Multimodal treatment; Salvage surgery; Transarterial chemoembolization