Transarterial chemoembolization in hepatocellular carcinoma: Can easy to use criteria determined after the first session predict survival? A multivariate analysis

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The efficacy of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) is still a matter of debate because of conflicting results, explained in part by variations in treatment indications and modalities. The aim of the present study was to determine whether simple routine parameters evaluating the Ist session ofTACE can predict survival. Patients and methods: From January 90 to January 99, 251 patients with HCC were treated in our department. Patients were included only when they were treated at least with one session of TACE and completed evaluation one month after TACE with CT scan. TACE session included hepatic arteriography, lipiodol and doxorubicin (50 mg/sm) emulsion injection, followed by gelatin sponge embolization. The following variables were studied in univariate and multivariate analysis: i) patient parameters (age, cirrhosis etiology, Child-Pugh class; ii) tumor parameters (tumor number, largest lesion size, alpha-fetoprotein concentration, existence of associated treatment) iii) TACE evaluation (variation in alfa-fetoprotein concentration, presence of post-embolization syndrome, i.e. hyperthermia, andlor cytolysis occurring within 2 days following TACE, and tumor lipiodol uptake. This last parameter was determined by the same radiologist by reading all CT scan without being informed of the study aim or patients survival. Results: 72 patients (mean age 66 yrs) fulfilled the inclusion criteria. HCC diagnosis was cytological in 94% and clinical in the remaining cases (imaging, alfa-fetoprotein level). 96% of patients had liver cirrhosis with Child-Pugh class A, Band C in respectively 66.7%, 27.5% and 5.8% of cases. Mean tumor number was 1.9 and the largest lesion had a mean diameter of 4.6 cm. Patient received a mean of 3 TACE session. 31 patients had associated treatment during folllow-up, Mean follow-up was 22.7 months. Mean survival was 30.4 months (median 22 months). Actuarial survival at 1,2,3 and 5 years was respectively 67.5%, 47.5%, 32.5%, and 20%. The only independant prognostic factor in multivariate analysis was the Child-Pugh class (p<O.OOI). None of our criteria evaluating the lst TACE session significantly influenced survival. Conclusions: The 3 parameters (variation in alfa-fetoprotein, post-embolization syndrome and lipiodol uptake) after the l st TAC did not predict survival.They could not be used to determine patients that could benefit from repeated TACE session.