Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence

Background and Objectives: The role of transarterial chemoembolization (TAC E) for inoperable hepatocellular carcinoma (HCC) has remained controversial , and its efficacy for postresection intrahepatic recurrence has not been f ully assessed. A study was performed to evaluate the treatment results and prognostic factors of TACE treatment in these patients. Methods: Clinicopathologic data and treatment results of 384 patients with inoperable HCC and 100 patients with postresection recurrent HCC treated wi th TACE were collected prospectively and analyzed. Results: TACE was associated with an overall treatment morbidity rate of 23 % (112/484) and mortality rate of 4.3% (21/484). A particularly high mortal ity rate of 20% (9/45) was observed among patients with tumors > 10 cm and pretreatment serum albumin level less than or equal to 35 g/L. The overall 1-year, 3-year, and 5-year survival rates from the time of first TACE treat ment were 49%, 23%, and 17% respectively. Tumor size less than or equal to 10 cm and serum albumin level > 35 g/L were independent favorable prognosti c factors. TACE in patients with postresection recurrent HCC was associated with less morbidity, mortality, and a better survival outcome compared wit h patients with primary inoperable HCC, but this was largely related to sma ller tumor size and better liver function in the former group at the time o f TACE treatment. Conclusions: TACE in patients with inoperable HCC was associated with signi ficant morbidity and mortality, and the survival benefit was limited. Bette r patient selection in terms of tumor size and liver function may improve t reatment results. Patients who have a tumor > 10 cm and poor liver function (serum albumin less than or equal to 35 g/L) may not be suitable candidate s for TACE treatment. (C) 2000 Wiley-Liss, Inc.