Risk factors for 1-year mortality in patients with intermediate-stage hepatocellular carcinoma treated solely with transcatheter arterial chemoembolization

Abstract

Summary Background/aims Transcatheter arterial chemoembolization (TACE) is a main therapy for patients with intermediate-stage hepatocellular carcinoma (HCC). The purpose of our study was to determine the risk factors for 1-year mortality in patients treated solely with TACE. Methods A total of 123 patients with intermediate-stage HCC treated solely with TACE were recruited from Ren-ai Branch, Taipei City hospital during the period from January 1998 to June 2013. Baseline characteristics and factors associated with 1-year mortality were analyzed. Results There were 94 men (76.4%) and 29 women (23.6%) among 123 newly diagnosed intermediate-stage HCC patients treated solely with TACE. The mean age was 63 ± 11 years (range, 31–92 years). The 1–5-year overall cumulative survival rates were 65.9%, 46%, 33.2%, 22%, and 18.4% [median: 23 months, 95% confidence interval (CI): 16.4–29.6 months], respectively. Of these, 42 (34.1%) and 81 (65.9%) patients had survival time shorter (Group 1) and longer (Group 2) than 1 year, respectively. There were no significant differences in sex, age, hepatitis B virus/hepatitis C virus positive rate and tumor number between Group 1 and Group 2 patients. Compared to Group 2, Group 1 patients had a significantly larger mean maximum tumor size (6.8 ± 3.2 cm vs. 5.3 ± 3.1 cm, p = 0.024), lower serum albumin level (3.4 ± 0.45 g/dL vs. 3.6 ± 0.46 g/dL, p = 0.011), higher serum bilirubin level (1.52 ± 1.07 mg/dL vs. 1.07 ± 0.59 mg/dL, p = 0.023), higher ratio of serum alpha-fetoprotein (AFP) > 400 ng/mL (52.4% vs. 24.7%, p = 0.003), and higher ratio of Child-Turcotte-Pugh (CTP) class B cirrhosis (26.2% vs. 6.2%, p = 0.003). Multivariate analysis revealed that AFP level > 400 ng/mL [hazard ratio (HR): 2.663, 95% CI: 1.143–6.205, p = 0.023], CTP class B cirrhosis (HR: 4.69, 95% CI: 1.399–15.715, p = 0.012) and tumor size (HR: 1.153 for each 1 cm increase, 95% CI: 1.015–1.310, p = 0.029) were independently associated with 1-year mortality. Conclusion One-year mortality in patients with intermediate-stage HCC treated solely with TACE is not uncommon. High serum AFP level (> 400 ng/mL), CTP class B cirrhosis, and tumor size are independent risk factors for 1-year mortality in those patients.