A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization

Background: Transcatheter arterial chemoembolization (TACE) has been used as a palliative treatment for patients with unresectable hepatocellular carcinoma (HCC), but its prognostic usefulness has not previously been clarified.

Methods: The authors reviewed all patients treated at their institution with TACE for unresectable HCC in order to analyze prognostic factors and to determine which patients might benefit from this treatment. One hundred forty-three patients were retrospectively studied. Pretreatment, treatment, and follow-up variables with possible prognostic significance were analyzed. A stepwise multivariate analysis was performed using the Cox regression model, and a prognostic index was obtained.

Results: According to univariate analysis, variables significantly associated with survival were alpha-fetoprotein (>400 U/L), tumor size (>50%), ascites, albumin (<30 g/L), Child-Pugh grade (Child C), Okuda stage (Okuda III), portal vein thrombosis, tumor greatest dimension larger than 5 cm, more than 3 nodules, bilobular involvement, and pattern of iodized oil uptake, tumor size reduction, and radiologic T classification on computed tomography scan performed 7 and 30 days after TACE. However, only ascites, alpha-fetoprotein (>400 U/L), tumor size (>50%), Child-Pugh grade (Child C), pattern of iodized oil uptake, and portal vein thrombosis were independent factors in multivariate analysis. Using the beta-coefficients of alpha-fetoprotein (>400 U/L), tumor size (>50%) and Child-Pugh score, a prognostic index was calculated, and according to this index patients were classified into 3 categories with different prognoses. Ascites was excluded from the analysis because it is included in Child-Pugh grade, and iodized oil uptake was excluded because it cannot be evaluated before treatment.

Conclusions: This simple prognostic index can predict the survival of patients treated with TACE and can therefore be used to decide which patients with unresectable HCC should receive this therapy. TACE should not be administered to patients with one or more positive prognostic factors.