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Comparison of transarterial chemoembolization and percutaneous acetic acid injection as the primary loco‐regional therapy for unresectable hepatocellular carcinoma: a prospective survey
Author(s) -
Huo T.,
Huang Y.H.,
Wu J.C.,
Chiang J.H.,
Lee P.C.,
Chang F.Y.,
Lee S.D.
Publication year - 2004
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2004.01996.x
Subject(s) - medicine , hepatocellular carcinoma , gastroenterology , percutaneous , confidence interval , relative risk , clinical endpoint , prospective cohort study , proportional hazards model , randomized controlled trial
Summary Background : Transarterial chemoembolization (TACE) and percutaneous acetic acid injection (PAI) are effective loco‐regional therapies for hepatocellular carcinoma (HCC). Aim : To compare the therapeutic efficacy of TACE vs. PAI for unresectable HCC. Methods : A total of 310 patients with unresectable HCCs (size ≤6 cm) undergoing TACE ( n = 195) or PAI ( n = 115) were studied prospectively. Overall and progression‐free survivals were measured endpoints. Results : The overall survival was not significantly different between the two groups ( P = 0.508). Among 129 patients with large (3.1–6 cm) HCCs, the overall survival was significantly better for the TACE group ( P = 0.018). Cox multivariate analysis showed that Child‐Pugh B [relative risk (RR): 4.2, 95% confidence interval (CI): 2.3–7.7, P < 0.001] and PAI therapy (RR: 1.4, 95%: 1.0–1.9, P = 0.057) were poor prognostic predictors; the progression‐free survival was also significantly better in the TACE group ( P = 0.038). Among 181 patients with small (≤3 cm) HCCs, there was no significant difference of overall survival ( P = 0.265) or progression‐free survival ( P = 0.146) between the two groups; Child‐Pugh B was the only prognostic factor predicting a decreased survival (RR: 2.8, 95% CI: 1.7–4.8, P < 0.001). Conclusions : Patients with large HCC undergoing TACE tend to have a more favourable long‐term outcome. For small HCC, either TACE or PAI therapy could be recommended as the primary treatment modality.