Single center experience over a 5-year period with sequential transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC)

Purpose: To analyze the course of disease of patients treated with sequential TACE and to evaluate the dependent and independent prognostic factors for patient survival using the Cox Proportional Hazard Model. Materials and Methods: 94 patients palliatively treated with TACE. Patients were selected if they had been treated at least 3 times. The TACE procedure was carried out at 8-week intervals using a Suspension consisting of a fixed dosage of Mitomycin C (10mg) and 10ml Lipiodol. Follow-up investigations included contrast-enhanced multislice CT before and after TACE and assessment of the laboratory test results (i.e., blood count, liver enzymes, and coagulation). Results: In 66.7% of the patients, multifocal tumors were found. In 16.0% of the patients, the tumor load represented more then 50% of the liver volume. In 23.4% of the cases, a portal vein thrombosis was found in the initial CT scan. The mean survival for the total cohort was 24.1 months (95%-Cl 20.1-28.2). During the investigation period, 72/94 of the patients died. The cumulative 1-year, 2-year, and 3-year survival rates are 71.6%, 33.9%, und 17.2%, respectively. A median of 6.0 +/- 3.1 (range 14, n total=612 TACE) was performed in each patient. A total of 62.5% patients died because of tumor progression whereas 18.1% died due to progressive liver failure. Patients in whom the tumor responded to the TACE treatment and who did not develop ascites or those with Okuda stage I or unifocal tumor growth showed a survival benefit whereas the presence of portal vein thrombosis was associated with a significantly poor outcome (p < 0.05). The Child-Pugh stage was not statistically significant for the disease course; the occurrence of new tumor lesions had no influence with regard to 1-year and 2-year survival but had a significant influence on long-term survival (p < 0,05). Independent prognostic factors are (multivariate analysis; p < 0.05): number of TACE performed, tumor type (i.e., unifocal vs. multifocal), response to TACE (response vs. progression), and Okuda stage. Conclusion: Our results emphasize the value of TACE in the palliative treatment of HCC. Under sequential TACE therapy the course of disease in patients suffering from portal vein thrombosis was not significantly worse. Crucial prognostic factors for the course of the HCC are tumor type and extension, response to TACE, and liver function at the beginning of TACE.