BACKGROUND: Transarterial chemoembolisation (TACE) is first-line treatment in unresectable hepatocellular carcinoma (HCC) and rescue treatment after failure of radical treatments in early stage HCC. Prognostic tools for HCC using time-fixed Cox models may be unreliable in patients treated with TACE because time-varying predictors interact. AIM: To explore time-dependent variables as survival predictors in patients with HCC receiving TACE as first-line or second-line treatment. METHODS: Eighty four consecutive patients with HCC (mean age 68; male gender 62%; Child-Pugh class: A n=73, B n=11; Barcelona Clinic Liver Cancer class: A n=44, B n=24, C n=16) treated with TACE were enrolled. Clinical, laboratory and radiological follow-up data were collected from the time of first treatment. Time-fixed and time-dependent Cox analyses were done. RESULTS: Overall survival rates were 89.6% (95% CI 82.5-97.2) at 12months, 58.8% (95% CI 46.2-74.9) at 24, 35.4% (95% CI 22.3-56.1) at 36 and 17.2% (95% CI 7.0-41.7) at 48months. Performance status (P<0.001), number of nodules (P<0.016) and prior therapy (P=0.017) were the only variables strongly linked to survival by time-fixed Cox model. Performance status (P<0.001), prior therapy (P=0.005), number of treatments (P=0.013), complete response after TACE (P=0.005) and bilirubin level (P<0.001) were associated with survival using a time-dependent Cox model. CONCLUSIONS: Survival after TACE is influenced most by performance status, complete response and bilirubin. Compared with the time-fixed models, a time-dependent Cox model has the potential to estimate a more precise prognosis in HCC patients treated with TACE.
BACKGROUND: Transarterial chemoembolisation (TACE) is first-line treatment in unresectable hepatocellular carcinoma (HCC) and rescue treatment after failure of radical treatments in early stage HCC. Prognostic tools for HCC using time-fixed Cox models may be unreliable in patients treated with TACE because time-varying predictors interact. AIM: To explore time-dependent variables as survival predictors in patients with HCC receiving TACE as first-line or second-line treatment. METHODS: Eighty four consecutive patients with HCC (mean age 68; male gender 62%; Child-Pugh class: A n=73, B n=11; Barcelona Clinic Liver Cancer class: A n=44, B n=24, C n=16) treated with TACE were enrolled. Clinical, laboratory and radiological follow-up data were collected from the time of first treatment. Time-fixed and time-dependent Cox analyses were done. RESULTS: Overall survival rates were 89.6% (95% CI 82.5-97.2) at 12months, 58.8% (95% CI 46.2-74.9) at 24, 35.4% (95% CI 22.3-56.1) at 36 and 17.2% (95% CI 7.0-41.7) at 48months. Performance status (P<0.001), number of nodules (P<0.016) and prior therapy (P=0.017) were the only variables strongly linked to survival by time-fixed Cox model. Performance status (P<0.001), prior therapy (P=0.005), number of treatments (P=0.013), complete response after TACE (P=0.005) and bilirubin level (P<0.001) were associated with survival using a time-dependent Cox model. CONCLUSIONS: Survival after TACE is influenced most by performance status, complete response and bilirubin. Compared with the time-fixed models, a time-dependent Cox model has the potential to estimate a more precise prognosis in HCC patients treated with TACE.
Authors: Francesco Agnello; Giuseppe Salvaggio; Giuseppe Cabibbo; Marcello Maida; Roberto Lagalla; Massimo Midiri; Giuseppe Brancatelli Journal: World J Hepatol Date: 2013-08-27
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Authors: Omar Hyder; Rebecca M Dodson; Hari Nathan; Joseph M Herman; David Cosgrove; Ihab Kamel; Jean-Francois H Geschwind; Timothy M Pawlik Journal: J Am Coll Surg Date: 2013-09-13 Impact factor: 6.113
Authors: Giuseppe Cabibbo; Marcello Maida; Chiara Genco; Pietro Parisi; Marco Peralta; Michela Antonucci; Giuseppe Brancatelli; Calogero Cammà; Antonio Craxì; Vito Di Marco Journal: World J Hepatol Date: 2012-09-27
Authors: Jon C Henry; Lavina Malhotra; Hooman Khabiri; Gregory Guy; Anthony Michaels; James Hanje; Marcela Azevedo; Mark Bloomston; Carl R Schmidt Journal: HPB (Oxford) Date: 2012-08-28 Impact factor: 3.647
Authors: Rebecca M Dodson; Amin Firoozmand; Omar Hyder; Vania Tacher; David P Cosgrove; Nikhil Bhagat; Joseph M Herman; Christopher L Wolfgang; Jean-Francois H Geschwind; Ihab R Kamel; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2013-09-25 Impact factor: 3.452