Survival outcomes in patients with advanced hepatocellular carcinoma treated with drug-eluting bead chemoembolization
Charles E Ray1, Anthony C Brown, Tyler J Green
11 Department of Radiology, University of Illinois at Chicago, 1740 W Taylor St, Mail Code 931, Chicago, IL 60612.
Insights
Drug-eluting bead (DEB) transarterial chemoembolization (TACE) therapy shows promise for advanced hepatocellular carcinoma (HCC). Survival is impacted by bilirubin levels and liver disease severity.
Area of Science:
- Hepatobiliary Surgery
- Interventional Radiology
- Oncology
Background:
- Advanced hepatocellular carcinoma (HCC) presents significant treatment challenges.
- Drug-eluting bead (DEB) therapy offers a targeted approach for HCC management.
Purpose of the Study:
- To evaluate overall survival rates in advanced HCC patients treated with DEB therapy.
- To identify prognostic factors influencing survival in this patient cohort.
Main Methods:
- Retrospective review of a single institution's HCC database (September 2008 - December 2011).
- Analysis of demographic, clinical, procedural, and outcome data.
- Survival stratification by Barcelona Clinic Liver Cancer (BCLC) stage, Child-Pugh class, ECOG score, bilirubin, and ethnicity.
Main Results:
- 43 advanced HCC patients met inclusion criteria; 30 were BCLC stage C, 13 were BCLC stage D.
- Median overall survival was 596 days; 23 patients survived, 12 receiving liver transplants.
- Elevated serum bilirubin (≥2.0 mg/dL) and Child-Pugh class B or C disease independently predicted poorer survival.
Conclusions:
- DEB-TACE is a safe and effective treatment for carefully selected advanced HCC patients.
- Prognostic factors like bilirubin levels and liver function are critical in treatment selection and outcome prediction.
Abstract:
OBJECTIVE. The purpose of this study was to determine the overall survival rates in patients with advanced hepatocellular carcinoma (HCC) who undergo treatment with drug-eluting bead (DEB) therapy. MATERIALS AND METHODS. A retrospective review of the clinical HCC database of a single institution was undertaken for patients treated between September 2008 and December 2011. Demographic information, laboratory and imaging findings, procedural details, and outcomes after treatment were obtained. The primary outcome was overall survival, which was stratified by Barcelona Clinic Liver Cancer (BCLC) stage, Child-Pugh class, Eastern Cooperative Oncology Group (ECOG) score, serum bilirubin level, and ethnicity. Multiple secondary independent variables were also measured. RESULTS. Of 239 consecutive patients treated during the prescribed time frame, 43 patients met the inclusion criteria. Thirty patients met the criteria for BCLC stage C, and 13 met the criteria for BCLC stage D based largely on ECOG score. Eight patients had venous invasion or portal venous thrombosis, and four had limited extrahepatic metastases. Eight patients had Child-Pugh class C liver disease but remained candidates for liver transplant based on the Milan criteria. The median overall survival was 596 days; 23 patients are still alive, 12 of whom underwent liver transplant. The only independent variables affecting survival were serum bilirubin value of 2.0 mg/dL or greater (hazard ratio [HR] = 3.96; 95% CI, 1.46-10.7; p = 0.007) and Child-Pugh class B or C disease (HR = 3.33; 95% CI, 1.07-10.34; p = 0.037). CONCLUSION. The use of DEBs for TACE therapy is safe and effective in carefully selected patients with advanced HCC.
