Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with child's grade A or B cirrhosis - A multivariate analysis of prognostic factors

We evaluated factors affecting long-term survival after transcatheter arter ial chemoembolization (TACE) for hepatocellular carcinoma (HCC) complicatin g cirrhosis. One hundred eighty-two patients with Child's class A or B cirr hosis and an HCC, not amenable to surgery or percutaneous ethanol injection , underwent 346 TACEs (mean 1.9) with epirubicin, iodized oil, and gelatin sponge, Many prognostic factors were subjected to univariate analysis and t hereafter, when significant, to the Cox's hazard proportional model. Finall y, the significant indices in the Cox's model were used to estimate the acc uracy of the probability of death with computation of the area under the re ceiving operative characteristic (ROC) curve. The cumulative survival rates at 1, 2, 3, and 5 years were 0.83, 0.52, 0.40, and 0.16, respectively. Acc ording to Cox's model, the factors associated with significantly worse surv ival were the presence of ascites (p = 0.0027), elevated bilirubin levels ( p = 0.0163), elevated oc-fetoprotein (alpha FP) values (p = 0.0067), a tumo r greater than 5 cm in diameter (p = 0.0001), and the absence of a tumor ca psule-like rim (p = 0.0278). According to these parameters, the accuracy of the probability of death estimated with ROC analysis was 0.63. Minor and m ajor complications occurred in 82 patients (45%) and caused death in 2 pati ents. Long-term prognosis after TACE for HCCs in patients with Child's clas s A or B cirrhosis depends on the presence of ascites, the bilirubin level, the aFP value, the diameter of the tumor, and the presence of a tumor caps ule-like rim. However, when considered altogether, these variables are poor predictors to evaluate survival, and other factors should be investigated to identify subjects more responsive to TACE. Complications occur in a high percentage of patients, but they do not affect long-term prognosis.