Factors Affecting Outcomes in Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization

摘要

Background: Outcome after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) is highly variable. Aims: To identify factors affecting outcome after TACE for HCC. Methods: We conducted a retrospective analysis of HCC patients treated with TACE from January 2001 to December 2010 at the VA Medical Center, Gainesville, Florida using Fisher’s exact test and Mann Whitney U testfor univariate analysis and the Kaplan-Meier method and Cox proportional hazard models to compare survival. Results:Of the 82 patients included in the analysis, 45 received doxorubicin drug eluting beads (DEB TACE) and 37 received conventional (CON) TACE. The two TACE groups had similar characteristics except for MELD score being higher in the CON TACE. Univariate analysis showed survival to be associated with type of TACE (p= 0.022), Child-Pugh (CP) class (p= 0.038), MELD score (p= 0.028), AFPmax (p=0.0002) and response after first TACE (p= 0.006). Kaplan Meier analysis showed significant survival benefit (p=0.014) in the DEB TACE group over the CON TACE group -26.4 months VS 15.8 months respectively and in patients with lower MELD scores (p=0.005). A multivariable analysis showed a significant interaction between type of TACE and MELD score ( p=0.395), with DEB TACE patients experiencing a better survival than CON TACE patients but the effect diminishing as MELD scores increased. In addition the risk of death increased significantly with AFPmax (Hazard ratio 1.15, 95%CI= [1.06, 1.26], p=0.0001). Conclusions: Survival after TACE for HCC is better after DEB TACE, in CP class A, with lower MELD score and lower AFPmax.