Factors Affecting Outcomes in Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization: A Retrospective Analysis
Patients with hepatocellular carcinoma (HCC) have a wide range of results after transarterial chemoembolization (TACE).
The purpose of this study is to determine which factors influence the result of TACE for HCC.
Methods: We used Fisher’s exact test and Mann Whitney U test for univariate analysis and the Kaplan-Meier technique and Cox proportional hazard models to assess survival in HCC patients treated with TACE at the VA Medical Center in Gainesville, Florida, from January 2001 to December 2010.
Results: A total of 82 patients were enrolled in the study, 45 of whom received doxorubicin drug eluting beads (DEB TACE) and 37 of whom received conventional (CON) TACE. With the exception of the CON TACE’s higher MELD score, the two TACE groups shared identical features. Survival was linked with TACE type (p= 0.022), Child-Pugh (CP) class (p= 0.038), MELD score (p= 0.028), AFPmax (p=0.0002), and response after first TACE (p= 0.006) in univariate analysis. The DEB TACE group had a substantial survival benefit (p=0.014) over the CON TACE group (-26.4 months versus 15.8 months, respectively) and in patients with lower MELD levels (p=0.005), according to Kaplan Meier analysis. A multivariable analysis found a statistically significant interaction between TACE type and MELD score (p=0.395), with DEB TACE patients outliving CON TACE patients, but the effect lessening as MELD levels climbed. Furthermore, AFPmax significantly increased the chance of death (hazard ratio 1.15, 95 percent CI= [1.06, 1.26], p=0.0001). Conclusions: In CP class A, survival following TACE for HCC is improved after DEB TACE, with a lower MELD score and AFPmax.
Author (s) Details
University of Florida, Gainesville and VA Medical Center, Gainesville, Florida, United States.
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