I-Cheng Lee1,2, Teh-Ia Huo1,3, Yi-Hsiang Huang4,5, Yee Chao6, Chung-Pin Li1, Pui-Ching Lee1, Jen-Huey Chiang7, Chien-Wei Su1,2, Keng-Hsin Lan1,3, Chih-Ming Yang1, Jaw-Ching Wu8,2, Han-Chieh Lin1, Shou-Dong Lee1. 1. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan. 2. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. 3. Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan. 4. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan. yhhuang@vghtpe.gov.tw. 5. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. yhhuang@vghtpe.gov.tw. 6. Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan. 7. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan. 8. Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.
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.
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: J Bruix; M Sherman; J M Llovet; M Beaugrand; R Lencioni; A K Burroughs; E Christensen; L Pagliaro; M Colombo; J Rodés Journal: J Hepatol Date: 2001-09 Impact factor: 25.083
Authors: Thomas Yau; Pierre Chan; Kelvin K Ng; Sin Ho Chok; Tan To Cheung; Sheung Tat Fan; Ronnie T Poon Journal: Cancer Date: 2009-01-15 Impact factor: 6.860
Authors: Josep M Llovet; Sergio Ricci; Vincenzo Mazzaferro; Philip Hilgard; Edward Gane; Jean-Frédéric Blanc; Andre Cosme de Oliveira; Armando Santoro; Jean-Luc Raoul; Alejandro Forner; Myron Schwartz; Camillo Porta; Stefan Zeuzem; Luigi Bolondi; Tim F Greten; Peter R Galle; Jean-François Seitz; Ivan Borbath; Dieter Häussinger; Tom Giannaris; Minghua Shan; Marius Moscovici; Dimitris Voliotis; Jordi Bruix Journal: N Engl J Med Date: 2008-07-24 Impact factor: 91.245