Hong Kong Med J 2009;15:339-45 | Number 5, October 2009
Outcome of inoperable hepatocellular carcinoma patients receiving transarterial chemoembolisation: a real-life retrospective analysis in a Hong Kong regional hospital
WM Yip, HG Hung, KH Lok, KF Li, KK Li, ML Szeto
Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong
OBJECTIVE. To evaluate survival and prognostic factors in patients with advanced hepatocellular carcinoma treated by transarterial chemoembolisation in a real-life clinical practice setting.
DESIGN. Retrospective study.
SETTING. Regional hospital, Hong Kong.
PATIENTS. Patients with inoperable hepatocellular carcinoma diagnosed from January 1998 to December 2003 who received transarterial chemoembolisation.
RESULTS. A total of 74 patients were identified, and had a median survival of 214 days. The cumulative survival rates at 1, 2, and 3 years were 28%, 12%, and 7%, respectively. By multivariate analysis, superselective cannulation performed in transarterial chemoembolisation (hazard ratio=0.47; 95% confidence interval, 0.23-0.95; P=0.034), embolisation with gelfoam (0.30; 0.11-0.80; P=0.017), and treatment intervals of more than 45 days (0.33; 0.15-0.72; P=0.006) were independent predictors of good survival. Child-Pugh grade B cirrhosis (hazard ratio=5.62; 95% confidence interval, 2.11-14.97; P=0.001), and high pre-treatment serum alpha-fetoprotein level (2.93; 1.50-5.73; P=0.002) were independent predictors of poor survival.
CONCLUSIONS. In real-life clinical practice, survival of patients with inoperable hepatocellular carcinoma remains grave despite treatment. Patients with Child-Pugh grade A cirrhosis or with low pretreatment alpha-fetoprotein level are more suitable for this form of treatment. The procedure should be performed with superselective cannulation and embolisation with gelfoam.
Key words: Carcinoma, hepatocellular; Chemoembolization, therapeutic; Liver neoplasms; Prognosis; Survival rate
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