title: Transarterial Chemoembolization for the Treatment of Advanced-Stage Hepatocellular Carcinoma.
abstract: It remains controversial whether transarterial chemoembolization (TACE) should be performed in patients with advanced-stage hepatocellular carcinoma (HCC). The present large retrospective cohort study aimed to define the survival outcome following TACE of advanced HCC and to identify the prognostic factors. Five hundred eight patients with Barcelona Clinic Liver Cancer (BCLC) C-stage HCC, Child-Pugh A/B who were treated with TACE between November 1998 and December 2013 were identified. There was no significant difference in overall survival (OS) between patients with Eastern Cooperative Oncology Group (ECOG) 0 and those with ECOG ≥1 (10.5 months vs. 11.9 months, P = 0.87). The median OS of patients without portal vein tumor thrombosis (PVTT) was longer than that of patients with PVTT (16.9 vs. 6.1 months, P < 0.001). Child-Pugh B class, PVTT, extrahepatic metastasis, tumor size ≥5 cm, number of tumors ≥3, and alpha-fetoprotein ≥400 ng/dL were significantly associated with decreased survival and were used for determining the risk scores. All patients were divided into two groups (low-risk and high-risk groups) according to the cutoff value of 6.5 for risk scores. The patients with a value <6.5 (low-risk group) had significantly longer survival than those with >6.5 (high-risk group) (24.1 vs. 7.5 months, respectively; P < 0.001). TACE is an effective therapy for select patients with advanced stage HCC and may provide equal or improved survival as compared with reported outcomes with sorafenib. The results highlight the need for a differentiated approach to therapeutic recommendations for patients with BCLC C.
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.|Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Chairman's Office, 333 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Chairman's Office, 333 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Duran
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Chairman's Office, 333 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Julius
authors.initials: J
authors.lastname: Chapiro
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Chairman's Office, 333 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Sohn
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Chairman's Office, 333 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Sahu
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Chairman's Office, 333 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Florian
authors.initials: F
authors.lastname: Fleckenstein
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
authors.forename: Susanne
authors.initials: S
authors.lastname: Smolka
authors.affiliation: Department of Surgery, The Ohio State University, Columbus, OH, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Chairman's Office, 333 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Schernthaner
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Chairman's Office, 333 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Chairman's Office, 333 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
authors.forename: Shuixiang
authors.initials: S
authors.lastname: He
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Chairman's Office, 333 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.|U/S Imaging and Interventions (UII), Philips Research North America, Cambridge, MA, USA.
authors.forename: MingDe
authors.initials: M
authors.lastname: Lin
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Chairman's Office, 333 Cedar Street, TE 2-230, New Haven, CT, 06520, USA. jeff.geschwind@yale.edu.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Geschwind
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000556:secondary / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011169:Portal Vein; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden; D020246:Venous Thrombosis / Q000150:complications; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000970:Antineoplastic Agents; D000509:alpha-Fetoproteins
keywords: Barcelona Clinic Liver Cancer; Hepatocellular carcinoma; Overall survival; Transarterial chemoembolization