Experience from a real-life cohort: outcome of 606 patients with hepatocellular carcinoma following transarterial chemoembolization. (2nd January 2017)

• Record Type: Journal Article
• Authors: Kirstein, Martha M.; Schweitzer, Nora; Ay, Nazli; Boeck, Christina; Lappas, Katerina; Hinrichs, Jan B.; Voigtländer, Torsten; Wacker, Frank; Manns, Michael P.; Rodt, Thomas; Vogel, Arndt
• Is Part Of: Scandinavian journal of gastroenterology. Volume 52:Number 1(2017)
• Page Start: 116
• Page End: 124
• Publication Date: 2017-01-02
• Subjects: Hepatocellular carcinoma -- TACE -- prognosis -- score -- liver transplantation; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.1080/00365521.2016.1233579
• Languages: English
• ISSNs: 0036-5521

Abstract

Abstract: Background: Hepatocellular carcinoma (HCC) is one of the most lethal cancers. Transarterial chemoembolization (TACE) has been accepted as the standard care for intermediate stage disease. Methods: In this study, we characterized 606 with HCC patients from Hannover Medical School treated with TACE. Results: 606 with HCC patients treated with TACE were identified between 2000 and 2015. Most patients (59.8%) were at intermediate stage. Following TACE, most patients subsequently received systemic therapy or best supportive care (BSC), whereas 227 (37.5%) patients were bridged to potentially curative local treatments. Depending on subsequent therapies, median post-TACE survival ranged from 7 to 162 months. Ascites, cholinesterase, c-reactive and alpha-feto protein and tumor size were identified as prognostic factors. These factors as well as the HAP, mHAP-II and STATE score also determined post-TACE survival independent of subsequent therapies. Hepatic function progressively deteriorated with repeated TACE sessions. Despite that, post-TACE survival was not shortened in frequently treated patients (≥5 times) as compared to patients treated 4 times or less (p = not significant [n.s.]). Patients treated ≥5 times with TACE received significantly more often systemic therapy following TACE (37.3%) as compared to patients with 3–4 (30.1%), 2 (27.4%) and 1 (21.8%) sessions ( p < .05). Conclusion: TACE is performed in a heterogeneous population as bridging therapy to other local treatments and palliative therapy. The long-term survival following TACE is determined by baseline tumor, patient-related factors and by subsequent therapies. Post-TACE survival is not shorter in patients with frequent treatments (≥5), and the rate of subsequent systemic treatments is higher compared to less frequently treated patients.