Abstract
PurposeTo develop the treatment algorithm from multivariate survival analyses (MVA) in patients with Barcelona clinic liver cancer (BCLC) C (advanced) Hepatocellular carcinoma (HCC) patients treated with Trans-arterial Chemoembolization (TACE).MethodsConsecutive unresectable and non-tranplantable patients with advanced HCC, who received DEB TACE were studied. A total of 238 patients (mean age, 62.4yrs) was included in the study. Survivals were analyzed according to different parameters from the time of the 1st DEB TACE. Kaplan Meier and Cox Proportional Hazard model were used for survival analysis. The SS was constructed from MVA and named BCLC C HCC Prognostic (BCHP) staging system (SS).ResultsOverall median survival (OS) was 16.2 months. In HCC patients with venous thrombosis (VT) of large vein [main portal vein (PV), right or left PV, hepatic vein, inferior vena cava] (22.7%) versus small vein (segmental/subsegmental PV) (9.7%) versus no VT had OSs of 6.4 months versus 20 months versus 22.8 months respectively (p<0.001). On MVA, the significant independent prognostic factors (PFs) of survival were CP class, eastern cooperative oncology group (ECOG) performance status (PS), single HCC<5 cm, site of VT, metastases, serum creatinine and serum alpha-feto protein. Based on these PFs, the BCHP staging system was constructed. The OSs of stages I, II and III were 28.4 months, 11.8 months and 2.4 months accordingly (p<0.001). The treatment plan was proposed according to the different stages.ConclusionOn MVA of patients with advanced HCC treated with TACE, significant independent prognostic factors (PFs) of survival were CP class, ECOG PS, single HCC<5 cm or others, site of VT, metastases, serum creatinine and serum alpha-feto protein. New BCHP SS was proposed based on MVA data to identify the suitable advanced HCC patients for TACE treatments.
Highlights
Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver, accounts for the sixth most common malignancy worldwide [1] and the third most common cause of cancer-related death globally behind only lung and stomach cancers [2]
On multivariate survival analyses (MVA) of patients with advanced HCC treated with Trans-arterial Chemoembolization (TACE), significant independent prognostic factors (PFs) of survival were CP class, eastern cooperative oncology group (ECOG) performance status (PS), single HCC
New BCLC C HCC Prognostic (BCHP) SS was proposed based on MVA data to identify the suitable advanced HCC patients for TACE treatments
Summary
Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver, accounts for the sixth most common malignancy worldwide [1] and the third most common cause of cancer-related death globally behind only lung and stomach cancers [2]. Because most patients present with advanced disease, curative surgical resection is an option for less than 20% of the patients [3] and their available treatment options are different locoregional therapies. Among these unresectable HCC patients, the patients with advanced stage HCC have limited treatment options [4,5,6]. Several doxorubicin drug eluting beads trans-arterial chemoembolization (DEB TACE) studies have shown survival benefits in patients with advanced stage HCC [7, 8]. As most HCC patients present with advanced disease, it is important to identify the independent variables of improved survival after TACE and to identify the BCLC C (advanced stage) HCC patients who can get maximum benefit from TACE.
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