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Up‐to‐seven criteria as a useful predictor for tumor downstaging to within Milan criteria and Child–Pugh grade deterioration after initial conventional transarterial chemoembolization
Author(s) -
Yasui Yutaka,
Tsuchiya Kaoru,
Kurosaki Masayuki,
Takeguchi Takaya,
Takeguchi Yuko,
Okada Mao,
Wang Wan,
Kubota Yohei,
Goto Tomoyuki,
Komiyama Yasuyuki,
Higuchi Mayu,
Takaura Kenta,
Hayashi Tsuguru,
Takada Hitomi,
Tamaki Nobuharu,
Nakanishi Hiroyuki,
Itakura Jun,
Takahashi Yuka,
Asahina Yasuhiro,
Enomoto Nobuyuki,
Himeno Yoshiro,
Izumi Namiki
Publication year - 2018
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.13048
Subject(s) - medicine , milan criteria , hepatocellular carcinoma , univariate analysis , liver function , hazard ratio , gastroenterology , logistic regression , odds ratio , prothrombin time , multivariate analysis , surgery , confidence interval , liver transplantation , transplantation
Aim Intermediate‐stage hepatocellular carcinoma varies widely in tumor burden and liver function. This study aimed to clarify the importance of subclassification by the up‐to‐seven criteria in both clinical course and liver function deterioration in such patients. Methods We retrospectively analyzed 224 patients with Child–Pugh grade A who underwent initial transarterial chemoembolization (TACE) for hepatocellular carcinoma. Tumor downstaging to within the Milan criteria within 1 year and liver function worsening as Child–Pugh grade deterioration from A to B were analyzed. Results The median survival time was 35.8 months. Forty‐five patients had no recurrence within 1 year after initial TACE. Of the 179 patients with at least one recurrence within a year, 44 (25%) achieved tumor downstaging to within the Milan criteria and showed significantly longer survival than non‐downstaged ones ( P = 0.02). Logistic regression univariate analysis revealed that up‐to‐seven criteria fulfillment was associated with tumor downstaging to within the Milan criteria (odds ratio 2.6; P = 0.007). The median deterioration time was 26.7 months. Multivariate analysis revealed that beyond the up‐to‐seven criteria (hazard ratio [HR] 1.9; P = 0.005) was an independent factor associated with Child–Pugh grade deterioration, along with serum albumin (HR 1.54; P = 0.01), serum bilirubin (HR 1.49; P = 0.02), and prothrombin time (HR 1.54; P = 0.04). Conclusions The up‐to‐seven criteria had prognostic value and could predict non‐critical recurrence and maintenance of Child–Pugh grade in patients who underwent initial conventional TACE.