Supportive treatment, resection and transcatheter arterial chemoembolization in resectable hepatocellular carcinoma: an analysis of survival in 419 patients
Yh. Huang et al., Supportive treatment, resection and transcatheter arterial chemoembolization in resectable hepatocellular carcinoma: an analysis of survival in 419 patients, EUR J GASTR, 11(3), 1999, pp. 315-321
Objective and design Both surgical resection and transcatheter arterial che
moembolization (TACE) are effective treatments for hepatocellular carcinoma
(HCC). Few reports have compared the different treatment modalities for re
sectable HCC based on clinically matched groups. The aim of this study was
to compare the survival rate after surgery, TACE or supportive treatment in
resectable HCC patients, and also in elderly patients (greater than or equ
al to 70 y/o).
Methods From 1984 to 1993, 419 consecutive patients with resectable HCC wer
e included in this study. Of these, 311 (74%) underwent resection of tumour
s and 46 (11%) refused operation, opting instead for TACE. The remaining 62
(15%) who refused both methods of treatment were given supportive care. Un
ivariate and multivariate analyses for prognostic factors and the 5-year su
rvival rate among the groups were studied.
Results Both surgical resection and TACE groups had a better B-year surviva
l rate than the supportive treatment group (43% and 34% vs, 7%). There was
no difference in survival between the surgery and TACE groups. However, the
5-year survival rate was 11% in TACE and 41% in the surgical group when th
e patients were less than or equal to 70, In multivariate analysis, female
sex (P=0.0466), tumour size less than or equal to 3 cm (P=0.0001), alpha-fe
toprotein (AFP) < 400 U/I (P= 0.0036), single tumour (P=0.0474), serum crea
tinine less than or equal to 1.5 mg/dl (P=0.0006) and alkaline phosphatase
(AP) less than or equal to 100 U/I (P=0.0007) are associated with good prog
nosis for resectable HCC.
Conclusion TACE is an alternative for resectable HCC. Tumour size, tumour n
umber, AFP level, renal function, AP level and female sex are prognostic fa
ctors. In elderly people, TACE must be used prudently and has a worse progn
osis. Eur J Gastroenterol Hepatol 11:315-321 (C) 1999 Lippincott Williams &
Wilkins.