Chemoembolization Endpoints: Effect on Survival Among Patients With Hepatocellular Carcinoma

OBJECTIVE. The purpose of this study was to investigate the relation between angiographic embolic endpoints of transarterial chemoembolization (TACE) and the survival of patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS. This study was a retrospective assessment of the cases of 105 patients with surgically unresectable HCC who underwent TACE. The cases were classified according to a previously established subjective angiographic chemoembolization endpoint scale. Only one patient had endpoint level I embolization and was excluded from all subsequent analysis. Survival was evaluated with Kaplan-Meier analysis. The Cox proportional hazards model was used to determine independent prognostic risk factors of survival. RESULTS. The overall median survival period was 21.1 months (95% CI, 15.9-26.4 months). Patients with embolization to subjective angiographic chemoembolization endpoint levels II and III were aggregated and had a significantly longer median survival period (25.6 months; 95% CI, 16.2-35.0 months) than patients with embolization to level IV (17.1 months; 95% CI, 13.3-20.9 months) (p = 0.035). The results of multivariate analysis indicated that all of the following factors were independent negative prognostic indicators of survival: subjective angiographic chemoembolization endpoint level IV (hazard ratio [HR], 2.49; 95% CI, 1.41-4.42; p = 0.002), European Cooperative Oncology Group performance status greater than 0 (HR, 1.97; 95% CI, 1.15-3.37; p = 0.013), American Joint Committee on Cancer stage III or IV (HR, 2.42; 95% CI, 1.27-4.60; p = 0.007), and Child-Pugh class B (HR, 1.94; 95% CI, 1.09-3.46; p = 0.025). CONCLUSION. Embolization to an intermediate, substasis endpoint (subjective angiographic chemoembolization endpoint levels II and III) during TACE improves survival compared with embolization to a higher, stasis endpoint (level IV). Interventional oncologists should consider aiming for these intermediate, substasis angiographic endpoints during TACE.