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Keywords:

  • hepatocellular carcinoma;
  • metastasis;
  • transarterial chemoembolization;
  • sorafenib;
  • survival analysis

Abstract

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.