Analysis of survival and prognostic factors in treatment of hepatocellular carcinoma in Spanish patients with drug-eluting bead transarterial chemoembolization

Jordi Sánchez-Delgado, Mercedes Vergara, Salvador Machlab, Alba Lira, Carlos Gómez Zaragoza, Eva Criado, Mercè Rosinach, Lissette Batista, Beatriz Arau, Mercè Roget, Jordi Ortiz, Caridad Garcia, Pau Sort, Meritxell Casas, Blai Dalmau, Montserrat Forné, Joan Falcó, Mireia Miquel

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    Abstract

    © 2018 Wolters Kluwer Health, Inc. All rights reserved. Background and aim Drug-eluting bead transarterial chemoembolization (DEB-TACE) improves the survival of patients with hepatocellular carcinoma (HCC), intermediate stage [i.e. Barcelona Clinic Liver Cancer-B (BCLC-B)]. The aim of our study was to analyse the overall survival (OS) and prognostic factors of patients with HCC treated with DEB-TACE. Patients and methods Patients' clinical course was recorded from January 2005 to July 2014. The median OS was obtained by the Kaplan-Meier method and compared using the log-rank test. The prognosis factors associated with OS were determined by a multivariate Cox regression analysis and the accuracy of the OS prediction was determined by calculation of the assessment for retreatment with TACE score (ART score). Results A cohort of 147 consecutive patients treated with DEB-TACE was included. Median age of the patients was 73.4 years. Overall, 68.7% were men, and all had cirrhosis, with 68.8% being hepatisis C virus positive. Moreover, 35.2% were staged as BCLC-A and 60.2% as BCLC-B. After a median follow-up of 19.2 months, 29.3% were alive, 4.3% needed treatment with sorafenib and 56.1% underwent DEB-TACE retreatment. Median OS was 22.8 [95% confidence interval (CI)=19.6-25.9]. After censoring for ascites and more than one nodule, OS was 23.87 (95% CI =20.72-27.01) and 26.89 (95% CI =21.00-32.78), respectively. The risk of death decreased by 22.3% with the number of DEB-TACE sessions (hazard ratio=0.777) and increased by 25.9% with higher Child-Pugh score (hazard ratio=1.259). Overall, 61.2% of the cohort had an ART score between 0 and 1.5. There were no statistical differences in OS between cohort groups with ART of 0-1.5 and at least 2.5. Conclusion The results validate the efficacy and safety of DEB-TACE in patients with HCC and the importance of some prognostic factors for patient survival.
    Original languageEnglish
    Pages (from-to)1453-1460
    JournalEuropean Journal of Gastroenterology and Hepatology
    Volume30
    DOIs
    Publication statusPublished - 1 Dec 2018

    Keywords

    • drug-eluting beads
    • hepatocellular carcinoma
    • prognostic factors
    • survival analysis
    • transarterial chemoembolization

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