title: Transarterial chemoembolization can prolong survival for patients with metastatic hepatocellular carcinoma: a propensity score matching analysis.
abstract: BACKGROUND
  In Asian countries, transarterial chemoembolization (TACE) is widely applied in hepatocellular carcinoma (HCC) patients with extra-hepatic metastasis in the absence of main portal vein thrombosis. However, its survival benefit is unclear. The study aimed to analyze the role of TACE in patients with metastatic HCC.
  
  
  METHODS
  From 2002 to 2009, 2,165 consecutive HCC patients were retrospectively reviewed. Of the 893 Barcelona Clinic Liver Cancer stage C patients, 105 who had extra-hepatic metastasis on initial presentation without main portal vein thrombosis were enrolled, including 46 who received TACE (TACE group) and 59 who received supportive treatment (control group). Factors associated with survival were evaluated by multivariate analysis. Survival between the two groups was compared by propensity score matching analysis.
  
  
  RESULTS
  Median survival in the TACE and control groups was 6.6 and 3.2 months, respectively (p < 0.001). By multivariate analysis, TACE [hazard ratio (HR) = 0.476, p = 0.002], tumor size >10 cm (HR = 1.606, p = 0.045), and alpha-fetoprotein (AFP) >2,000 ng ml(-1) (HR = 1.599, p = 0.037) were factors associated with survival. After propensity score matching analysis, a better survival was noted in the TACE group (median survival 4.0 vs. 3.0 months, p = 0.029). Subgroup analysis showed that patients with tumor size ≤10 cm and AFP levels ≤2,000 ng ml(-1) had the best survival from TACE. Smaller tumor size is the only independent predictor for survival longer than 6 months in patients receiving TACE.
  
  
  CONCLUSIONS
  TACE provides survival benefit for metastatic HCC patients. Prospective randomized controlled trials are warranted to delineate the role of combining TACE with sorafenib or other treatment for metastatic HCC.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan.|Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: I-Cheng
authors.initials: IC
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan.|Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan. yhhuang@vghtpe.gov.tw.|Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. yhhuang@vghtpe.gov.tw.
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.affiliation: Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yee
authors.initials: Y
authors.lastname: Chao
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan.
authors.forename: Chung-Pin
authors.initials: CP
authors.lastname: Li
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan.
authors.forename: Pui-Ching
authors.initials: PC
authors.lastname: Lee
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Jen-Huey
authors.initials: JH
authors.lastname: Chiang
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan.|Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Su
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan.|Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Keng-Hsin
authors.initials: KH
authors.lastname: Lan
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan.
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Yang
authors.affiliation: Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Jaw-Ching
authors.initials: JC
authors.lastname: Wu
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan.
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan.
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
keywords: Hepatocellular carcinoma (HCC); Metastasis; Propensity score; Survival; Transarterial chemoembolization (TACE)