Hepatocellular carcinoma : treated with hepatic arterial embolization, an analysis of prognostic features in 150
C Eurvilaichit1, A Kanjanapitak
1Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Transcatheter oily chemoembolization (TOCE) is superior to transarterial embolization (TAE) for hepatocellular carcinoma (HCC). TOCE combined with surgical resection offers the best survival outcomes for HCC patients.
Area of Science:
- Hepatobiliary Medicine
- Surgical Oncology
- Interventional Radiology
Background:
- Hepatocellular carcinoma (HCC) is a significant global health concern.
- Effective treatment strategies for HCC are crucial for improving patient survival.
- Various therapeutic modalities exist, necessitating comparative analysis.
Purpose of the Study:
- To retrospectively analyze prognostic features and compare treatment outcomes for hepatocellular carcinoma (HCC).
- To evaluate the efficacy of transarterial embolization (TAE), transcatheter oily chemoembolization (TOCE), and TOCE with surgical resection.
- To identify significant prognostic factors influencing treatment results in HCC patients.
Main Methods:
- Retrospective analysis of 150 HCC patients treated between July 1989 and July 1999.
- Patients were categorized into three groups based on treatment: TAE, TOCE, and TOCE with surgical wedge hepatic resection.
- Life-table methods were employed to analyze survival rates and prognostic factors.
Main Results:
- Transcatheter oily chemoembolization (TOCE) demonstrated superior outcomes compared to transarterial embolization (TAE).
- The combination of TOCE and surgical wedge hepatic resection yielded the best cumulative survival rate (median survival 46.69 months).
- Tumor stage, serum biochemistry, and tumor size were identified as significant prognostic factors for HCC treatment outcomes.
Conclusions:
- Transcatheter oily chemoembolization (TOCE) is a more effective treatment modality than transarterial embolization (TAE) for hepatocellular carcinoma.
- Combining TOCE with surgical wedge hepatic resection represents the optimal treatment strategy for improving long-term survival in HCC patients.
- Tumor characteristics and patient's hepatic reserve function are critical determinants of treatment success in hepatocellular carcinoma.
Abstract:
From July 1989 to July 1999, 120 male and 30 female patients with hepatocellular carcinoma (HCC), whose ages ranged from 18 to 71 years, were treated by different modalities. The patients were divided into 3 groups according to treatment modalities: group 1 consisted of 35 cases treated by transarterial embolization (TAE) using gelatin sponge permeated with mitomycin-c 20 mg, group 2 - 100 cases treated by transcatheter oily chemoembolization (TOCE) using lipiodol 10 cc with mitomycin-c 20 mg together with gelatin sponge for hepatic embolization, and group 3 - 15 cases treated by TOCE followed by surgical wedge hepatic resection. The prognostic features following treatments were retrospectively analysed in relation to therapeutic modalities. The results revealed that TOCE was superior to TAE and that TOCE plus adjunct wedge hepatic resection was the best treatment modality with the best cumulative surgical rate (median survival 46.69 months). Analysis of the life-table methods of group 2 patients revealed that the stage of tumors and serum biochemistry on entry, both of which corresponded well with hepatic reserve function were statistically significant prognostic factors for treatment result and long-term outcomes. Further analysis of all the patients also revealed that tumor size and stage of tumors were significant prognostic factors for the treatment of hepatocellular carcinomas.
