Efficacy and Safety of Conventional Transarterial Chemo-embolization for Patients with Advanced Stage Hepatocellular Carcinoma
Chalermrat Bunchorntavakul MD*, Benjarat Promjunyakul MD**, Wansiri Thummakomut MD***
Affiliation : * Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
Background : Transarterial chemo-embolization (TACE) is the standard care for patients with intermediate stage hepatocellular
carcinoma (HCC); however, in real-world practice, TACE is sometimes utilized in patients with more advanced stage HCC,
including those with portal vein thrombosis/invasion (PVT) and/or extrahepatic metastasis. The efficacy and safety data of
TACE in these contingencies are limited.
Objective : To evaluate the efficacy and safety of TACE in patients with intermediate (BCLC-B) and advanced (BCLC-C) stages
HCC as defined by Barcelona Clinic Liver Cancer (BCLC) staging system.
Material and Method: Data of consecutive patients with intermediate and advanced HCC who underwent TACE between
January 2008 and December 2012 in the single tertiary center (Rajavithi Hospital, Bangkok) were retrospectively reviewed.
HCC patients with BCLC-B were classified as the “standard TACE criteria” (S-TACE) group, whereas patients with BCLC-
C were classified as the “extended TACE criteria” (E-TACE) group. The primary endpoint was the overall survival (OS).
Secondary endpoints were safety data and objective tumor response of TACE. Outcomes of patients with HCC BCLC-B/C who
refused TACE for personal reasons and received only supportive care (BSc cohort) were compared with those patients who
underwent TACE.
Results : A total of 110 HCC patients were included in the analysis: mean age 54 years, 53% hepatitis B positive, 23% Child-
Pugh B and 89% tumor size >5 cm. There was no significant difference in OS between the E-TACE group (n = 54) and S-
TACE (n = 56): OS 7.7 vs. 9.6 months; p = 0.535, respectively. Progressive disease by mRECIST criteria was more common
in the E-TACE group (31.5% vs. 10.7%, p = 0.007). Pre-treatment MELD score, PVT and TACE-related complications were
independent predictors for OS in multivariate analysis. The OS of patients with PVT (n = 40) was significantly lower than that
of those without it (5.6 vs. 11.2 months, p<0.001). There was no difference in OS between patients with (n = 31) and without
extrahepatic metastases (9.6 vs. 8.5 months, p = 0.784). TACE-related complications were uncommon and similar in the two
groups (p<0.05). The OS in the TACE cohort was significantly better than in the BSC cohort (n = 24) (8.8 vs. 3.1 months,
p<0.001).
Conclusion : The overall median survival and adverse events following TACE were similar in HCC patients with BCLC stage
B and C, and were better than those patients who received only supportive care. This finding supports the use of TACE in
selected patients with advanced HCC, including in those with extrahepatic metastasis.
Keywords : Hepatocellular carcinoma, Cirrhosis, Transarterial chemoembolization, Portal vein thrombosis, Advanced stage
