Abstract :
Background: Transarterial chemoembolization (TACE) is the standard of care for patients with intermediate
stage hepatocellular carcinoma (HCC). However, due to limited accessibility for targeted therapy, TACE is
sometimes utilized in patients with more advanced stages of HCC, including those with portal vein thrombosis/
invasion (PVT) and extra-hepatic metastases. Safety and efficacy data of TACE in these settings are limited.
Objective: To determine the efficacy and safety of TACE in patients with intermediate and advanced
stages of HCC according to Barcelona Clinic Liver Cancer (BCLC) staging system.
Methods: Data of consecutive patients with intermediate or advanced HCC who underwent TACE between
January 2008 and December 2012 in a single tertiary center (Rajavithi Hospital, Bangkok) were retrospectively
reviewed. TACE was performed under the standard hospital protocol by 3 experienced radio-interventionists.
HCC patients with BCLC-B were classified as “standard TACE criteria” group, whereas patients with BCLCC
were classified as “extended TACE criteria” group. The primary endpoint was an overall 2-year survival. Secondary
endpoints were safety and objective tumor response to TACE.
Results: A total of 110 HCC patients who underwent TACE were included in the analysis. There was no
significant difference in the overall survival between the standard criteria group (n=56) and the extended criteria
group (n=54): 2-year survival 15.2% vs 14.3%, p=0.555; median survival, 9.6 vs 7.7 months; p=0.535, respectively.
Progressive disease by modified RECIST criteria was more common in the extended criteria group (10.7%
vs 31.5%, p=0.007). Pre-treatment MELD score, PVT and TACE-related complications were independent factors
for survival in a multivariate analysis. The median survival of patients with and without PVT was 5.6 and 11.2
months (p<0.001), respectively. There was no difference in survival between patients with and without extrahepatic
metastases (9.6 vs 8.5 months, p=0.784). The incidence of TACE-related complications were similar between
the two groups (p<0.05): 32.1% liver decompensation and 3.6% death in the standard criteria group; and
35.2% liver decompensation and 5.6% death in the extended criteria group.
Conclusion: The overall median survival and adverse events following TACE were similar between
HCC patients with BCLC stage B and stage C. This finding supports the use of TACE to slow down HCC progression
in selected patients with BCLC-C, including those with extra-hepatic metastasis. |
file/Thai-Journal-of-gastroenterology-vol-17-no-1-4983481.pdf