Chemoembolization for Hepatocellular Carcinoma in Patients with Extrahepatic Spread: Prognostic Determinants and Appropriate Candidates

• Published in: Journal of vascular and interventional radiology Vol. 28; no. 7; pp. 956 - 962
• Main Authors: Wang, Enxin, MD, Liu, Lei, MD, Xia, Dongdong, MD, Wang, Wenjun, MD, Bai, Wei, MD, Wang, Qiuhe, MD, Yuan, Jie, MD, Li, Xiaomei, MD, Zhang, Lei, MD, Niu, Jing, MD, Yin, Zhanxin, MD, Xia, Jielai, MD, Cai, Hongwei, MD, Fan, Daiming, MD, PhD, Han, Guohong, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2017
• Subjects: Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic - methods; Female; Humans; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Male; Middle Aged; Neoplasm Metastasis; Patient Selection; Prognosis; Radiology; Risk Factors; Survival Rate; Treatment Outcome; Tumor Burden; PVTT; portal vein tumor thrombosis; CI; Eastern Cooperative Oncology Group; HCC; HR; AFP; extrahepatic spread; alpha fetoprotein; EHS; ECOG; hazard ratio; confidence interval; hepatocellular carcinoma
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2017.02.016

Abstract Purpose To investigate treatment outcome, prognostic factors for overall survival, and appropriate candidates for transarterial chemoembolization among patients with hepatocellular carcinoma (HCC) and extrahepatic spread (EHS). Materials and Methods From January 2010 to June 2014, 111 consecutive patients with HCC and EHS treated by transarterial chemoembolization alone were evaluated. Factors associated with overall survival were evaluated using Cox regression analysis, and a scoring equation was established to subgroup patients with EHS. Results Median follow-up was 3.8 months, and median overall survival was 3.8 months (95% confidence interval [CI], 2.9–4.7 months). Multivariate analysis demonstrated maximum tumor size ≥ 10 cm (hazard ratio [HR] 1.58; 95% CI, 1.02–2.46; P  = .041), multifocal intrahepatic tumors (HR 1.55; 95% CI, 1.03–2.33; P  = .037), and portal vein tumor thrombosis (PVTT) (HR 1.81; 95% CI, 1.12–2.91; P  = .015) as significant predictors of overall survival. Based on these factors, a scoring equation was developed to predict treatment outcome of transarterial chemoembolization, with an area under the receiver operating characteristic curve of 0.76 in predicting 6-month survival. Using a cutoff score of 5.5, patients with HCC and EHS were divided into 2 groups with significantly different overall survival (8.1 months for EHS1 and 2.4 months for EHS2; P < .001). The described method of subgrouping remained discriminatory regardless of baseline characteristics. Conclusions Maximum tumor size, intrahepatic tumor distribution, and presence of PVTT were significant determinants of overall survival for patients with HCC and EHS. Transarterial chemoembolization may be appropriate for patients with EHS but lower intrahepatic tumor burden.