Transcatheter arterial chemoembolisation for hepatocellular carcinoma in cirrhosis: Survival rate and prognostic factors

Olivo, Mirko; Valenza, Franco; Buccellato, Antonio; Scala, Lorenza; Virdone, Roberto; Sciarrino, Elio; Di Piazza, Sonia; Marrone, Ciro; Orlando, Ambrogio; Fusco, Giorgio; Madonia, Salvatore; Cottone, Mario

doi:10.1016/j.dld.2009.09.012

« Previous Next »Digestive and Liver Disease
Volume 42, Issue 7 , Pages 515-519, July 2010

Transcatheter arterial chemoembolisation for hepatocellular carcinoma in cirrhosis: Survival rate and prognostic factors

Mirko Olivo
- Medicine, Pneumatology and Nutrition Physiology Clinic, “V. Cervello” Hospital, Palermo University, Italy
- Corresponding author. Tel.: +39 03474997540; fax: +39 0916885111.
Franco Valenza
- Radiology Department, V. Cervello Hospital, Palermo, Italy
Antonio Buccellato
- Radiology Department, V. Cervello Hospital, Palermo, Italy
Lorenza Scala
- Medicine, Pneumatology and Nutrition Physiology Clinic, “V. Cervello” Hospital, Palermo University, Italy
Roberto Virdone
- Medicine, Pneumatology and Nutrition Physiology Clinic, “V. Cervello” Hospital, Palermo University, Italy
Elio Sciarrino
- Medicine, Pneumatology and Nutrition Physiology Clinic, “V. Cervello” Hospital, Palermo University, Italy
Sonia Di Piazza
- Gastroenterology Department, “V. Cervello” Hospital, Palermo, Italy
Ciro Marrone
- Medicine, Pneumatology and Nutrition Physiology Clinic, “V. Cervello” Hospital, Palermo University, Italy
Ambrogio Orlando
- Medicine, Pneumatology and Nutrition Physiology Clinic, “V. Cervello” Hospital, Palermo University, Italy
Giorgio Fusco
- Medicine, Pneumatology and Nutrition Physiology Clinic, “V. Cervello” Hospital, Palermo University, Italy
Salvatore Madonia
- Medicine, Pneumatology and Nutrition Physiology Clinic, “V. Cervello” Hospital, Palermo University, Italy
Mario Cottone
- Medicine, Pneumatology and Nutrition Physiology Clinic, “V. Cervello” Hospital, Palermo University, Italy

Received 10 March 2009; accepted 30 September 2009. published online 16 November 2009.

Abstract

Background

The role of prognostic variables in the treatment of hepatocellular carcinoma (HCC) by transarterial chemoembolisation (TACE) is controversial.

Aims

To evaluate the survival of patients with HCC on cirrhosis treated with TACE and to analyse the prognostic factors affecting survival.

Methods

From 1996 to 2006, 580 consecutive patients with HCC in cirrhosis were observed. Of these 194 patients underwent TACE. The primary end-point was survival. Independent predictors of survival were identified using the Cox model.

Results

The cumulative 1-year, 3-year, and 5-year survival rates were 96%, 60%, and 41%, respectively. The multivariate analysis showed significant reduction of survival among patients with serum bilirubin values >2mg/dl compared to patients with values <2mg/dl (Hazard ratio 3.84; CI 95% 1.70–8.66; p-value=0.001). Multivariate analysis performed in the group of patients treated with TACE alone showed that elevated serum bilirubin (Hazard ratio 2.96; CI 95% 1.20–7.3; p-value 0.02) and incomplete tumour response (Hazard ratio 2.88; CI 95% 1.18–7.05; p-value 0.02) are correlated with a worse outcome.

Conclusions

TACE was well tolerated and overall survival rate was 41% after 5 years. Complete tumour response and serum bilirubin <2mg/dl were identified as predictors of survival.

Keywords: Cirrhosis, Hepatocellular carcinoma, Prognostic factors, Transcatheter arterial chemoembolisation