Abstract :
Background: Transarterial chemoembolization (TACE) is one of the most common used treatment
modality for hepatocellular carcinoma (HCC) patients, especially in patients who can not undergo any curative treatments. Several studies have demonstrated the beneficial impact on survival. To date, the Barcelona Clinic Liver Cancer (BCLC) staging system is the most accepted staging system for HCC which provided treatment strategies according to the stage. Among the stage A, not all the patients were treated with surgery, local ablation or liver transplantation as the guideline for several reasons either unfavorable location of tumor, advanced stage of underlying liver disease, facility of the institution and shortage of organ donors. These patients were usually treated with TACE. In the stage B, which was recommended for TACE, there is still some different in regarding to size and number of tumor between the patients. Not all the stage A and B patients had survival benefit from TACE. Factoirs influencing the survival outcome should be evaluated.
Objectives: To evaluated the outcome of TACE using 5-fluorouracil plus mitomycin C in the different
stage of HCC patients based on the BCLC staging system and to evaluate the subgroups of patients in stage A and B who received the most survival benefit from TACE.
Patients and Methods: From January 1998 to November 2003, A total of 144 HCC patients treated only with TACE using 5-fluorouracil plus mitomycin C were analysed retrospectively for survival time in relation to the BCLC staging system.
Results: The one and two years survival rate of the patients in stage A (N = 33) were 66% and 39%,
stage B(N = 80) were 45%and 20% and stage C (N = 31) were 13% and 3%,respectively (p = 0.01). Based on the Child Pugh classification, the 1and 2 years survival rate of the stage A patients who wre in Child A (N = 24) were 78% and 45%, In Child B (N = 9) were 33% and 22%, respectively (p = 0.374). For the stage B patients, the 1 and 2 years survival rate in those with single tumor smaller than 10 cm (N = 25) were 50% and 40%, those with single tumor larger than 10 cm or multiple tumors (N = 55) were 40% and 10%, respectively (p = 0.01).
Conclusion : In the BCLC stage A patients, TACE seemed to show the 2 years survival benefit in those
with Child A. More data on Child B are needed to evaluate the survival advantage. In the BCLC stage B patients, those with single tumor smaller than 10 cm showed the best 2 years survival benefit than the others.
[Thai J Gastroenterol 2006; 7(3): 120-125] |
file/Thai-Journal-of-gastroenterology-vol-7-no-3-3439381.pdf