Predictors of survival following trans-arterial chemoembolization for the palliative treatment of hepatocellular carcinoma

Abstract

Introduction: Hepatocellular carcinoma (HCC) incidence is increasing worldwide. Trans-arterial chemoembolization (TACE) can prolong survival for those in whom curative treatment is contra-indicated. This study aimed to determine factors associated with survival in patients undergoing palliative TACE treatment of hepatocellular carcinoma. Methods: A retrospective analysis was performed of prospectively collected data on all patients within Edinburgh, Scotland receiving palliative TACE therapy for HCC between January 2009 and October 2016. Kaplan-Meier survival curves and Cox-Proportional Hazard Ratio univariate and multivariate analyses were performed to determine characteristics associated with increased survival benefit. Severity of liver disease was measured by UKELD score, a variant of MELD score. Results: 93 patients (mean age 66.7±9.1 years) underwent palliative TACE therapy. One and three year survival was 81% and 32% respectively. The mean UKELD score was 49.2±3.3. Patients had a median of two tumours (range 1-21) of maximum median size 38 (IQR 27-50) millimetres. Improved survival was observed in those patients who underwent more than one TACE (p=0.0002), had a maximum size of tumour under four centimetres (p=0.01) and a UKELD score of under 50 (p=0.03). An increased UKELD score was the only independent predictor of worse survival (HR 1.134 [95% CI 1.016-1.265] p=0.025). Portal hypertension, increased age, comorbidity or multifocal HCC were not associated with worse survival following multivariate analysis. Conclusions: In patients with HCC undergoing palliative TACE procedure, increased UKELD score is the only predictor of worse survival. This could be utilized during the patient selection process and risk assessment when determining management of HCC.