Korean J Radiol.  2008 Dec;9(6):534-540. 10.3348/kjr.2008.9.6.534.

Multivariate Analysis of the Predictors of Survival for Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Focusing on Superselective Chemoembolization

Affiliations
  • 1Department of Radiology, Seoul Veterans Hospital, Seoul, Korea. yunkucho2004@yahoo.co.kr

Abstract


OBJECTIVE
While the prognostic factors of survival for patients with hepatocellular carcinoma (HCC) who underwent transarterial chemoembolization (TACE) are well known, the clinical significance of performing selective TACE for HCC patients has not been clearly documented. We tried to analyze the potential factors of disease-free survival for these patients, including the performance of selective TACE. MATERIALS AND METHODS: A total of 151 patients with HCC who underwent TACE were retrospectively analyzed for their disease-free survival (a median follow-up of 23 months, range: 1-88 months). Univariate and multivariate analyses were performed for 20 potential factors by using the Cox proportional hazard model, including 19 baseline factors and one procedure-related factor (conventional versus selective TACE). The parameters that proved to be significant on the univariate analysis were subsequently tested with the multivariate model. RESULTS: Conventional or selective TACE was performed for 40 and 111 patients, respectively. Univariate and multivariate analyses revealed that tumor multiplicity, venous tumor thrombosis and selective TACE were the only three independent significant prognostic factors of disease-free survival (p = 0.002, 0.015 and 0.019, respectively). CONCLUSION: In our study, selective TACE was a favorable prognostic factor for the disease-free survival of patients with HCC who underwent TACE.

Keyword

Hepatocellular carcinoma; Survival; Therapy; Chemoembolization

MeSH Terms

Adult
Aged
Antibiotics, Antineoplastic/administration & dosage
Carcinoma, Hepatocellular/mortality/*therapy
*Chemoembolization, Therapeutic
Contrast Media/administration & dosage
Disease-Free Survival
Doxorubicin/administration & dosage
Female
Humans
Iodized Oil/administration & dosage
Liver Neoplasms/mortality/*therapy
Male
Middle Aged
Prognosis

Reference

1. Colella G, Bottelli R, De Carlis L, Sansalone CV, Rondinara GF, Alberti A, et al. Hepatocellular carcinoma: comparison between liver transplantation, resective surgery, ethanol injection, and chemoembolization. Transpl Int. 1998. 11:S193–S196.
2. Segawa T, Izawa K, Tsunoda T, Kanematsu T, Shima M, Matsunaga N, et al. Evaluation of hepatectomy in small hepatocellular carcinoma: comparison with transcatheter arterial embolization therapy. Nippon Geka Gakkai Zasshi. 1992. 93:1095–1099.
3. Nakamura H, Hashimoto T, Oi H, Sawada S. Transcatheter oil chemoembolization of hepatocellular carcinoma. Radiology. 1989. 170:783–786.
4. Bronowicki JP, Vetter D, Dumas F, Boudjema K, Bader R, Weiss AM, et al. Transcatheter oily chemoembolization for hepatocellular carcinoma. A 4-year study of 127 French patients. Cancer. 1994. 74:16–24.
5. Uchida H, Ohishi H, Matsuo N, Nishimine K, Ohue S, Nishimura Y, et al. Transcatheter hepatic segmental arterial embolization using lipiodol mixed with an anticancer drug and Gelfoam particles for hepatocellular carcinoma. Cardiovasc Interv Radiol. 1990. 13:140–145.
6. Takayasu K, Suzuki M, Uesaka K, Muramatsu Y, Moriyama N, Yoshida T, et al. Hepatic artery embolization for inoperable hepatocellular carcinoma: prognosis and risk factors. Cancer Chemother Pharmacol. 1989. 23:S123–S125.
7. Yamada R, Kishi K, Sonomura T, Tsuda M, Nomura S, Satoh M. Transcatheter arterial embolization in unresectable hepatoellular carcinoma. Cardiovasc Interv Radiol. 1990. 13:135–139.
8. Pelletier G, Roche A, Ink O, Anciaux ML, Derhy S, Rougier P, et al. A randomized trial of hepatic arterial chemoembolization in patients with unresectable hepatocellular carcinoma. J Hepatol. 1990. 11:181–184.
9. Madden MV, Krige JE, Bailey S, Beningfield SJ, Geddes C, Werner ID, et al. Randomised trial of targeted chemotherapy with lipiodol and 5-epidoxorubicin compared with symptomatic treatment for hepatoma. Gut. 1993. 34:1598–1600.
10. Bruix J, Llovet JM, Castells A, Montana X, Bur C, Ayuso MC, et al. Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology. 1998. 27:1578–1583.
11. Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire. A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma. N Engl J Med. 1995. 332:1256–1261.
12. Pelletier G, Ducreux M, Gay F, Luboinski M, Hagege H, Dao T, et al. Treatment of unresectable hepatocellular carcinoma with lipiodol chemoembolization: a multicenter randomized trial. Groupe CHC. J Hepatol. 1998. 29:129–134.
13. Llovet JM, Real MI, Montana X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomized controlled trial. Lancet. 2002. 359:1734–1739.
14. Lo CM, Ngan H, Tso WK, Lin CL, Lam CM, Poon RT, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002. 35:1164–1171.
15. Lee HS, Kim KM, Yoon JH, Lee TR, Suh KS, Lee KU, et al. Therapeutic efficacy of transcatheter arterial chemoembolization as compared with hepatic resection in hepatocellular carcinoma patients with compensated liver function in a hepatitis B virus-endemic area: a prospective cohort study. J Clin Oncol. 2002. 20:4459–4465.
16. Liem MS, Poon RT, Lo CM, Tso WK, Fan ST. Outcome of transarterial chemoembolization in patients with inoperable hepatocellular carcinoma eligible for radiofrequency ablation. World J Gastroenterol. 2005. 11:4465–4471.
17. O'Suilleabhain CB, Poon RT, Yong JL, Ooi GC, Tso WK, Fan ST. Factors predictive of 5-year survival after transarterial chemoembolization for inoperable hepatocellular carcinoma. Br J Surg. 2003. 90:325–331.
18. Stefanini GF, Amorati P, Biselli M, Mucci F, Celi A, Arienti V, et al. Efficacy of transarterial targeted treatments on survival of patients with hepatocellular carcinoma. An Italian experience. Cancer. 1995. 75:2427–2434.
19. Takayasu K, Muramatsu Y, Maeda T, Iwata R, Furukawa H, Muramatsu Y, et al. Targeted transarterial oily chemoembolization for small foci of hepatocellular carcinoma using a unified helical CT and angiography system: analysis of factors affecting local recurrence and survival rates. AJR Am J Roentgenol. 2001. 176:681–688.
20. Maeda S, Fujiyama S, Tanaka M, Ashihara H, Hirata R, Tomita K. Survival and local recurrence rates of hepatocellular carcinoma patients treated by transarterial chemolipiodolization with and without embolization. Hepatol Res. 2002. 23:202–210.
21. Matsui O, Kadoya M, Yoshikawa J, Gabata T, Tkashima T, Demachi H. Subsegmental transcatheter arterial embolization for small hepatocellular carcinomas: local therapeutic effect and 5-year survival rate. Cancer Chemother Pharmacol. 1994. 33:S84–S88.
22. Nishimine K, Uchida H, Matsuo N, Sakaguchi H, Hirohashi S, Nishimura Y, et al. Segmental transarterial chemoembolization with Lipiodol mixed with anticancer drugs for nonresectable hepatocellular carcinoma: follow-up CT and therapeutic results. Cancer Chemother Pharmacol. 1994. 33:S60–S68.
23. Matsui O, Kadoja M, Yoshikawa J, Gabata T, Takashima T, Demachi H. Small hepaocellular carcinoma: treatment with subsegmental arterial embolization. Radiology. 1993. 188:79–83.
24. Iwamoto S, Sanefuji H, Okuda K. Angiographic subsegmentectomy for the treatment of patients with small hepatocellular carcinoma. Cancer. 2003. 97:1051–1056.
25. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona 2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001. 35:421–430.
26. Jang KM, Choi D, Lim HK, Lim JH, Lee JY, Lee WJ, et al. Depiction of viable tumor in hepatocellular carcinoma treated with transarterial chemoembolization: multiphasic helical CT with review of the previous serial CT images. Korean J Radiol. 2005. 6:153–160.
27. Goldberg SN, Grassi CJ, Cardellar JF, Charboneau JW, Dodd GD 3rd, Dupuy DE, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol. 2005. 16:765–778.
28. Itamoto T, Nakahara H, Tashiro H, Ohdan H, Hino H, Ochi M, et al. Indications of partial hepatectomy for transplantable hepatocellular carcinoma with compensated cirrhosis. Am J Surg. 2005. 189:167–172.
29. Poon RT, Fan ST, Lo CM, Liu CL, Wong J. Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg. 2002. 235:373–382.
30. Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999. 16:329–338.
31. Sorensen JB, Klee M, Palshof T, Hansen HH. Performance status assessment in cancer patients. An interobserver variability study. Br J Cancer. 1993. 67:773–775.
32. Jang JW, Choi JY, Bae SH, Yoon SK, Woo HY, Chang UI, et al. The impact of hepatitis B viral load on recurrence after complete necrosis in patients with hepatocellular carcinoma who receive transarterial chemoembolization: implications for viral suppression to reduce the risk of cancer recurrence. Cancer. 2007. 110:1760–1767.
33. Izumi R, Shimizu K, Ii T, Yagi M, Matsui O, Nonomura A, et al. Prognostic factors of hepatocellular carcinoma in patients undergoing hepatic resection. Gastroenterology. 1994. 106:720–727.
34. Tsai TJ, Chau GY, Lui WY, Tsay SH, King KL, Loong CC, et al. Clinical significance of microscopic tumor venous invasion in patients with resectable hepatocellular carcinoma. Surgery. 2000. 127:603–608.
35. Jonas S, Bechstein WO, Steinmüller T, Herrmann M, Radke C, Berg T, et al. Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatology. 2001. 33:1080–1086.
Full Text Links
  • KJR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr