Survival of infiltrative hepatocellular carcinoma patients with preserved hepatic function after treatment with transart
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ORIGINAL PAPER
Survival of infiltrative hepatocellular carcinoma patients with preserved hepatic function after treatment with transarterial chemoembolization Eun Sun Jang • Jung-Hwan Yoon • Jin Wook Chung Eun Ju Cho • Su Jong Yu • Jeong-Hoon Lee • Yoon Jun Kim • Hyo-Suk Lee • Chung Yong Kim
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Received: 3 August 2012 / Accepted: 10 December 2012 / Published online: 3 January 2013 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Purpose Transarterial chemoembolization (TACE) is highly effective and safe therapeutic modality for unresectable hepatocellular carcinoma (HCC). However, the role of TACE for infiltrative HCC has never been elucidated owing to the concern about hepatic failure and subsequent mortality after the procedure. In this study, we aimed to document whether patients with infiltrative HCC would benefit from TACE. Methods Child-Pugh class A/B patients who were newly diagnosed as infiltrative HCC and treated with curativeintent TACE were enrolled. All radiological images were reviewed by a radiologist with more than 20 years of experience in TACE. Results Among 1,184 patients newly diagnosed as HCC, 233 (19.7 %) had infiltrative-type tumors and 128 (54.9 %) underwent curative-intent TACE. Although the median overall survival was 5.4 months (IQR 3.1–13.9 months) and 16 (12.5 %) patients had experienced significant complications, 19 (15.9 %) patients survived more than 2 years after the first diagnosis. In multivariable analysis, age [60 years E. S. Jang Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnamsi, Gyeonggido, Republic of Korea J.-H. Yoon (&) E. J. Cho S. J. Yu J.-H. Lee Y. J. Kim H.-S. Lee C. Y. Kim Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, 28 Yungun-dong, Chongno-gu, Seoul 110-744, Republic of Korea e-mail: [email protected] J. W. Chung Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
old (HR 0.54, 95 % CI 0.31–0.92), Child-Pugh class A (HR 0.48, 95 % CI 0.30–0.76), and a major PVT without parasitic supply (HR 0.66, 95 % CI 0.44–0.99) were independent favorable prognostic factors. Development of significant complication after TACE was a significant hazard factor of survival (HR 1.99, 95 % CI 1.09–3.62). Conclusions In carefully selected patients with preserved hepatic function and good performance, TACE may achieve long-term survival of infiltrative HCC patients with major PVT without parasitic supply. However, the risk of morbidity and immediate mortality after TACE should be considered to select subjects for the procedure. Keywords Carcinoma Hepatocellular Chemoembolization Therapeutic Portal vein/pathology Survival rate Risk factors Abbreviations HCC Hepatocellular carcinoma TACE Transarterial chemoembolization PVT Portal vein thrombosis BCLC Barcelona Clinic Liver Cancer ECOG Eastern Cooperative Oncology Group HBV Hepatitis B virus AFP a-Fetopro
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