Doxorubicin drug eluting beads transcatheter chemoembolization (DEB TACE) in patients with large hepatocellular carcinoma (HCC): Overall survival and a multivariate analysis (MVA) of prognostic factors.

Abstract

e15033 Background: To investigate the prognostic factors (PFs) associated with survival after DEB TACE in patients (pts) with at least > 5cm sized index HCC (iHCC). Methods: Consecutive pts with at least > 5cm sized iHCC, who received DEB TACE over last 82 months, were studied. Median overall survivals (mOSs) were analyzed according to different parameters from 1st DEB TACE. Kaplan Meier estimator by log rank test and Cox proportional Hazard model (for MVA) were used survival analyses using v20 SPSS. Results: 332 DEB TACEs (mean 3, medium 2) were performed in 112 pts (mean 62.1 years, SD 12), who had at least >5cm sized iHCC (mean 9.5 cm, SD 3.7). MOS from diagnosis and DEB TACE were 14.3 months (m) and 9.4 m respectively. MOS were 31.9 m, 11.1 m and 2.8 m in pts who received > 4, 2-4 and a 1 DEB TACEs respectively (p<0.001). Etiological factors for HCC were hepatitis C virus (54.4%), hepatitis B virus (12.5%), chronic alcoholism (7.1%), other causes of chronic liver disease (17%) and unknown with no chronic liver disease (9%); mOS were 8.8 m, 4.4 m, 5.8 m, 27 m, and 9.4 m respectively (p=0.01). MOS in pts with Child-Pugh Class A (58.9%), B (34.8%) and C (6.3%) were 17.2 m, 5.8 m and 1.6 m respectively (p<0.001). MOS in pts with BCLC stage B (17%), C (69.6%) and D (13.4%) were 20.9 m, 9.4 m, and 3.4 m respectively (p=0.003). 46.4% of pts had portal vein thrombosis (PVT) with mOS of 5.4 m vs. 17.1m in pts without PVT (p=0.006). Pts with serum alfa feto protein (sAFP) level>400 ng/dl (43.7%) had mOS of 5.4 m vs. 16.6 m in pts with sAFP<400ng/dl (p=0.008). 32.1% of pts received sorafenib systemic chemotherapy; mOS were 13.3m vs. 7.6m who did not receive the sorafenib (p=0.2). Pts with >5 HCCs (20.5%) had mOS of 5.4m vs. 13m in pts who had <5 HCCs (p=0.009). The following variables were independent significant PFs of survival on MVA: Child-Pugh class, etiology, number (no) of DEB TACEs, presence of vascular invasion and ECOG PS. Conclusions: Higher number of DEB TACE treatments correlates independently to improved OS in patients with at least >5cm sized index HCC. Other independent PFs of survival were etiology, Child-Pugh class, no of HCC tumors, ECOG PS and PVT.