Open AccessRisk factors for 1‐year mortality in patients with intermediate‐stage hepatocellular carcinoma treated solely with transcatheter arterial chemoembolization
Author(s) -
Lin ChihLin,
Hsieh ChiaFeng,
Chen Tom,
Lin TsungJung,
Huang TingChang,
Lee HsiChang,
Chen KuanYang,
Liao LiYing,
Wang ChungKwe
Publication year - 2014
Publication title -
advances in digestive medicine
Language(s) - English
Resource type - Journals
ISSN - 2351-9800
DOI - 10.1016/j.aidm.2013.12.001
Subject(s) - medicine , hepatocellular carcinoma , transcatheter arterial chemoembolization , gastroenterology , stage (stratigraphy) , hepatitis b virus , confidence interval , hepatitis b , bilirubin , survival rate , carcinoma , surgery , virus , immunology , paleontology , biology
Summary Background/aims Transcatheter arterial chemoembolization (TACE) is a main therapy for patients with intermediate‐stage hepatocellular carcinoma (HCC). The purpose of our study was to determine the risk factors for 1‐year mortality in patients treated solely with TACE. Methods A total of 123 patients with intermediate‐stage HCC treated solely with TACE were recruited from Ren‐ai Branch, Taipei City hospital during the period from January 1998 to June 2013. Baseline characteristics and factors associated with 1‐year mortality were analyzed. Results There were 94 men (76.4%) and 29 women (23.6%) among 123 newly diagnosed intermediate‐stage HCC patients treated solely with TACE. The mean age was 63 ± 11 years (range, 31–92 years). The 1–5‐year overall cumulative survival rates were 65.9%, 46%, 33.2%, 22%, and 18.4% [median: 23 months, 95% confidence interval (CI): 16.4–29.6 months], respectively. Of these, 42 (34.1%) and 81 (65.9%) patients had survival time shorter (Group 1) and longer (Group 2) than 1 year, respectively. There were no significant differences in sex, age, hepatitis B virus/hepatitis C virus positive rate and tumor number between Group 1 and Group 2 patients. Compared to Group 2, Group 1 patients had a significantly larger mean maximum tumor size (6.8 ± 3.2 cm vs. 5.3 ± 3.1 cm, p = 0.024), lower serum albumin level (3.4 ± 0.45 g/dL vs. 3.6 ± 0.46 g/dL, p = 0.011), higher serum bilirubin level (1.52 ± 1.07 mg/dL vs. 1.07 ± 0.59 mg/dL, p = 0.023), higher ratio of serum alpha‐fetoprotein (AFP) > 400 ng/mL (52.4% vs. 24.7%, p = 0.003), and higher ratio of Child‐Turcotte‐Pugh (CTP) class B cirrhosis (26.2% vs. 6.2%, p = 0.003). Multivariate analysis revealed that AFP level > 400 ng/mL [hazard ratio (HR): 2.663, 95% CI: 1.143–6.205, p = 0.023], CTP class B cirrhosis (HR: 4.69, 95% CI: 1.399–15.715, p = 0.012) and tumor size (HR: 1.153 for each 1 cm increase, 95% CI: 1.015–1.310, p = 0.029) were independently associated with 1‐year mortality. Conclusion One‐year mortality in patients with intermediate‐stage HCC treated solely with TACE is not uncommon. High serum AFP level (> 400 ng/mL), CTP class B cirrhosis, and tumor size are independent risk factors for 1‐year mortality in those patients.