Abstract
Background: Hepatocellular carcinoma (HCC) patient’s outcomes after transarterial chemoembolization (TACE) are highly variable. Aims: The goal of this study is to find out what factors influence the outcome of TACE for HCC. Methods: We performed a retrospective analysis of HCC patients treated with TACE at the VA Medical Center in Gainesville, Florida, from January 2001 to December 2010, using Fisher's exact test and Mann Whitney U test for univariate analysis and the Kaplan-Meier method and Cox proportional hazard models to compare survival. Results: The study included 82 patients, 45 of whom received doxorubicin drug eluting beads (DEB TACE) and 37 of whom received conventional (CON) TACE. The two TACE groups had similar characteristics, with the exception of the CON TACE having a higher MELD score. Univariate analysis showed survival to be associated with type of TACE (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). Kaplan Meier analysis showed significant survival benefit (p=0.014) in the DEB TACE group over the CON TACE group -26.4 months VS 15.8 months respectively and in patients with lower MELD scores (p=0.005). A multivariable analysis revealed a statistically significant interaction between TACE type and MELD score( p=0.395), with DEB TACE patients experiencing a better survival than CON TACE patients but the effect diminishing as MELD scores increased. Furthermore, the risk of death increased significantly with AFPmax (Hazard ratio 1.15, 95%CI= [1.06, 1.26], p=0.0001). Conclusions: Survival after TACE for HCC is better after DEB TACE, in CP class A, with lower MELD score and lower AFPmax.
Published Version
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