Experience from a real-life cohort: outcome of 606 patients with hepatocellular carcinoma following transarterial chemoembolization.
BACKGROUND
Hepatocellular carcinoma (HCC) is one of the most lethal cancers. Transarterial chemoembolization (TACE) has been accepted as the standard care for intermediate stage disease.


METHODS
In this study, we characterized 606 with HCC patients from Hannover Medical School treated with TACE.


RESULTS
606 with HCC patients treated with TACE were identified between 2000 and 2015. Most patients (59.8%) were at intermediate stage. Following TACE, most patients subsequently received systemic therapy or best supportive care (BSC), whereas 227 (37.5%) patients were bridged to potentially curative local treatments. Depending on subsequent therapies, median post-TACE survival ranged from 7 to 162 months. Ascites, cholinesterase, c-reactive and alpha-feto protein and tumor size were identified as prognostic factors. These factors as well as the HAP, mHAP-II and STATE score also determined post-TACE survival independent of subsequent therapies. Hepatic function progressively deteriorated with repeated TACE sessions. Despite that, post-TACE survival was not shortened in frequently treated patients (≥5 times) as compared to patients treated 4 times or less (p = not significant [n.s.]). Patients treated ≥5 times with TACE received significantly more often systemic therapy following TACE (37.3%) as compared to patients with 3-4 (30.1%), 2 (27.4%) and 1 (21.8%) sessions (p < .05).


CONCLUSIONS
TACE is performed in a heterogeneous population as bridging therapy to other local treatments and palliative therapy. The long-term survival following TACE is determined by baseline tumor, patient-related factors and by subsequent therapies. Post-TACE survival is not shorter in patients with frequent treatments (≥5), and the rate of subsequent systemic treatments is higher compared to less frequently treated patients.
a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany.
Martha M
MM
Kirstein
a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany.
Nora
N
Schweitzer
a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany.
Nazli
N
Ay
a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany.
Christina
C
Boeck
a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany.
Katerina
K
Lappas
b Institute for Radiology , Hannover Medical School , Hannover , Germany.
Jan B
JB
Hinrichs
a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany.
Torsten
T
Voigtländer
b Institute for Radiology , Hannover Medical School , Hannover , Germany.
Frank
F
Wacker
a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany.
Michael P
MP
Manns
b Institute for Radiology , Hannover Medical School , Hannover , Germany.
Thomas
T
Rodt
a Department of Gastroenterology, Hepatology and Endocrinology , Hannover Medical School , Hannover , Germany.
Arndt
A
Vogel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D005858:Germany; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
Hepatocellular carcinoma; TACE; liver transplantation; prognosis; score