TRANSARTERIAL CHEMOEMBOLIZATION COULD ACHIEVED A SURVIVAL BENEFIT IN SELECTED PATIENTS WHO HAVE ADVANCED STAGE OF HEPATOCELLULAR CARCINOMA

Abstract

Introduction: Recent guideline for hepatocellularcarcinoma(HCC) recommended transarterial chemoembolization (TACE) only in patients with intermediate stage of BCLC system. However, it has not been validated between intermediate and advanced stage. Although recent advent of sorafenib(over-all survival 10.7 months), there is no other proven effective modality in patients with advanced stage of BCLC system, therefore many of these patients are undergoing TACE and sometimes achieved considerable benefit. The aims of this study were to validate recent guideline for TACE between intermediate and advanced stage and to investigate the prognostic predictor in patients with advanced stage.

Methods: We enrolled 160 newly diagnosed HCC patients who had intermediate(Group I ) or advanced stage(Group II), underwent TACE as initial modality at least two times consecutively and did not take any other modality during 3 months after initial TACE.

Results: The baseline characteristics of 92 patients in Group I and 68 patients in Group II were not significantly different : male/ female, mean age, etiology(B/C/alcohol/unkown), Child-Pugh class(A/B) were 77/15 vs. 55/13, 59.3 vs. 56.5, 67/10/13/2 vs. 50/7/7/4, 70/22 vs. 54/14, respectively. In Group II patients, the number of patients who had portal vein thrombosis(PVT), lymph node metastasis(LN) and distant metastasis(DM) were 45, 20 and 4, respectively. The median survival time was 21.5 months(3-113) in Group I and 10 months(3-90) in Group II, it was significantly different(log-rank test, p<0.000). In univriate analysis to investigate prognostic predictor in Group II patients, only the presence of PVT(9 months in PVT vs.16 months in non-PVT, p=0.023) was significant predictor for poor survival. The presence of DM(6 months in DM vs. 11 months in non-DM, p=0.065) and the presence of main PVT(7 months in main PVT vs. 11 months in non-main PVT, p=0.057) showed a trend of poor prognosis. However, sex, age, etiology, the presence of LN, size of tumor, number of tumor, and Child-Pugh class did not showed any significant difference. In multivariated cox regression analysis, the presence of main PVT(p=0.04, 95% CI; 1.03-4.13) and DM(p=0.047, 95% CI; 1.01-8.43) was significant predictors for poor survival.

Conclusion: In HCC patients who underwent TACE, patients with advanced stage showed significantly poor prognosis than patients with intermediate stage. However, even in patients with advanced stage, patients without main portal vein thrombosis or distant metastasis could achieved considerable survival benefit. It might be advocated that TACE could be applied in selected patients even with advanced stage of HCC.