Clinical outcome of 251 patients with extrahepatic metastasis at initial diagnosis of hepatocellular carcinoma: does transarterial chemoembolization improve survival in these patients?

J Gastroenterol Hepatol. 2011 Jan;26(1):145-54. doi: 10.1111/j.1440-1746.2010.06341.x.

Abstract

Background and aims: The therapeutic efficacy of transarterial chemoembolization (TACE) has not been evaluated in hepatocellular carcinoma (HCC) patients with extrahepatic metastasis. We investigated the efficacy of TACE with/without systemic chemotherapy (s-chemo) in these patients.

Methods: We performed a survival analysis of consecutive HCC patients with extrahepatic metastasis, diagnosed at initial presentation according to treatment modality after stratification, using the Child-Pugh classification and intrahepatic HCC T stage, retrospectively.

Results: Between 2005 and 2007, 251 patients were newly diagnosed with HCC involving extrahepatic metastasis at our institution. Among those, 226 were classified as Child-Pugh A-B and the other 25, Child-Pugh C. Within the Child-Pugh A-B group, repeated TACE or transarterial chemoinfusion (TACI) was performed with/without s-chemo in 171 patients. Eight of 226 received s-chemo alone, and 47, conservative management (CM) alone. The median survival time of patients treated with TACE/TACI with s-chemo, TACE/TACI alone, and CM was 10, 5, and 2.9 months in patients classified as Child-Pugh A and T3-stage HCC (TACE/TACI with s-chemo vs CM, P=0.0354; TACE/TACI alone vs CM, P=0.0553) and 7.1, 2.6, and 1.6 months in Child-Pugh B and T3-stage patients, respectively (TACE/TACI with s-chemo vs CM, P=0.0097; TACE/TACI alone vs CM, P<0.0001). Individual treatment with TACE/TACI or sorafenib showed independent prognostic significance in the multivariate analysis.

Conclusion: Repeated TACE could show significant survival benefits in metastatic HCC patients with conserved liver function and intrahepatic HCC T3 stage. The survival data of our study could be used as a historical control for TACE monotherapy in future clinical trials evaluating combination treatments containing TACE in these patients.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Benzenesulfonates / administration & dosage
  • Carcinoma, Hepatocellular / drug therapy
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / secondary
  • Carcinoma, Hepatocellular / therapy*
  • Cause of Death
  • Chemoembolization, Therapeutic*
  • Chi-Square Distribution
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Liver Neoplasms / drug therapy
  • Liver Neoplasms / mortality
  • Liver Neoplasms / pathology
  • Liver Neoplasms / therapy*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Niacinamide / analogs & derivatives
  • Phenylurea Compounds
  • Proportional Hazards Models
  • Protein Kinase Inhibitors / administration & dosage
  • Pyridines / administration & dosage
  • Republic of Korea
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Sorafenib
  • Survival Rate
  • Time Factors
  • Treatment Outcome
  • Young Adult

Substances

  • Benzenesulfonates
  • Phenylurea Compounds
  • Protein Kinase Inhibitors
  • Pyridines
  • Niacinamide
  • Sorafenib