TACE performed in patients with a single nodule of hepatocellular carcinoma

Eleonora Terzi, Fabio Piscaglia, Ludovica Forlani, Cristina Mosconi, Matteo Renzulli, Luigi Bolondi, Rita Golfieri, BLOG-Bologna Liver Oncology Group, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy, Eleonora Terzi, Fabio Piscaglia, Ludovica Forlani, Cristina Mosconi, Matteo Renzulli, Luigi Bolondi, Rita Golfieri, BLOG-Bologna Liver Oncology Group, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

Abstract

Background: Patients with single hepatocellular carcinoma (HCC) usually undergo transarterial chemoembolization (TACE) if they are not candidates for curative surgical or ablative therapy. The primary aim of the study was to assess the overall survival and clinical determinants of survival in patients with single HCC who underwent TACE. The secondary aims were tumor response, local and distant recurrence rates, time to recurrence and the impact of TACE on liver function.

Methods: The outcomes of 148 consecutive patients with single HCC who underwent TACE from January 2004 to December 2009 were retrospectively analyzed.

Results: Complete response (CR) was observed in 95/148 (64%) patients and a partial response (PR) in 39 (26%) patients. The recurrence rate was 27%, 42% and 65% at 6, 12 and 24 months, respectively. The day after TACE, 56 (38%) patients had a Child-Pugh increase ≥ 1 and 93 (63%) had a MELD increase ≥ 1. Median survival was 36.0 months with 1-, 3- and 5-year survival rates of 85%, 50% and 26%, respectively. Bland portal thrombosis was not seen to have any impact at univariate survival analysis; however, a slight impairment of PS (PS-1) in small tumors had some, although minor, impact on prognosis. Factors associated with shorter survival at multivariate analysis were tumor >5 cm, absence of CR, ascites, alpha-fetoprotein (AFP) ≥ 14.5 ng/mL and a MELD increase ≥ 1.

Conclusions: Transarterial chemoembolization is a valid treatment option in patients with single HCC not suitable for curative treatment. Bland PVT has no major impact on survival and a slight impairment of PS attributable to cirrhosis in patients within the Milan criteria should not preclude the use of TACE.

Figures

Figure 1
Figure 1
Flow chart of the study population.
Figure 2
Figure 2
Impact of TACE on laboratory tests one day after the procedure. (A) Modification of serum albumin (P < 0.001); (B) modification of serum bilirubin (P < 0.001); (C) modification of serum INR (P = 0.003); (D) modification of serum creatinine (P = 0.823); (E) modification of MELD score (P < 0.001).
Figure 3
Figure 3
Overall survival according to BCLC tumor stage.

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