Clinical outcome of 251 patients with extrahepatic metastasis at initial diagnosis of hepatocellular carcinoma: Does transarterial chemoembolization improve survival in these patients?
Article first published online: 31 MAR 2010
© 2010 The Authors; © 2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 26, Issue 1, pages 145–154, January 2011
How to Cite
Yoo, D.-J., Kim, K. M., Jin, Y.-J., Shim, J. H., Ko, G.-Y., Yoon, H.-K., Sung, K.-B., Lee, J.-L., Kang, Y.-K., Lim, Y.-S., Lee, H. C., Chung, Y.-H., Lee, Y. S. and Suh, D. J. (2011), Clinical outcome of 251 patients with extrahepatic metastasis at initial diagnosis of hepatocellular carcinoma: Does transarterial chemoembolization improve survival in these patients?. Journal of Gastroenterology and Hepatology, 26: 145–154. doi: 10.1111/j.1440-1746.2010.06341.x
- Issue published online: 22 DEC 2010
- Article first published online: 31 MAR 2010
- Accepted manuscript online: 4 AUG 2010 12:00PM EST
- Accepted for publication 15 March 2010.
- hepatocellular carcinoma;
- transarterial chemoembolization;
- survival analysis
Background and Aims: The therapeutic efficacy of transarterial chemoembolization (TACE) has not been evaluated in hepatocellular carcinoma (HCC) patients with extrahepatic metastasis. We investigated the efficacy of TACE with/without systemic chemotherapy (s-chemo) in these patients.
Methods: We performed a survival analysis of consecutive HCC patients with extrahepatic metastasis, diagnosed at initial presentation according to treatment modality after stratification, using the Child–Pugh classification and intrahepatic HCC T stage, retrospectively.
Results: Between 2005 and 2007, 251 patients were newly diagnosed with HCC involving extrahepatic metastasis at our institution. Among those, 226 were classified as Child–Pugh A–B and the other 25, Child-Pugh C. Within the Child–Pugh A–B group, repeated TACE or transarterial chemoinfusion (TACI) was performed with/without s-chemo in 171 patients. Eight of 226 received s-chemo alone, and 47, conservative management (CM) alone. The median survival time of patients treated with TACE/TACI with s-chemo, TACE/TACI alone, and CM was 10, 5, and 2.9 months in patients classified as Child–Pugh A and T3-stage HCC (TACE/TACI with s-chemo vs CM, P = 0.0354; TACE/TACI alone vs CM, P = 0.0553) and 7.1, 2.6, and 1.6 months in Child–Pugh B and T3-stage patients, respectively (TACE/TACI with s-chemo vs CM, P = 0.0097; TACE/TACI alone vs CM, P < 0.0001). Individual treatment with TACE/TACI or sorafenib showed independent prognostic significance in the multivariate analysis.
Conclusion: Repeated TACE could show significant survival benefits in metastatic HCC patients with conserved liver function and intrahepatic HCC T3 stage. The survival data of our study could be used as a historical control for TACE monotherapy in future clinical trials evaluating combination treatments containing TACE in these patients.