Predictors of outcome in patients with unresectable hepatocellular carcinoma receiving transcatheter arterial chemoembolization.

Background: Transcatheter arterial chemoembolization (TACE) has been shown to improve survival in patients with unresectable hepatocellular carcinoma (HCC).

Aim: To identify pretreatment factors that predicts increased mortality in HCC patients receiving TACE.

Methods: Retrospective review of all patients who underwent TACE for HCC from January 1999 to November 2004. Patient demographics, aetiology of liver disease, laboratory and imaging data regarding tumour characteristics were obtained.

Results: Eighty-eight patients (57 +/- 1 years age) received 1-4 sessions of TACE (1.4 +/- 0.1). Tumour size was 3.3 +/- 0.2 cm (range 1-13 cm, median 3 cm) with mean number of lesions 1.9 +/- 0.1 (range 1-7). Mean model for the end stage liver disease score: 11 +/- 0.4; cancer of the liver Italian program score: 1.3 +/- 0.1. Survival post-TACE (excluding those underwent orthotopic liver transplantation) was 12 +/- 0.3 months. By multivariate analysis, tumour size (HR = 1.37, 95% CI: 1.11-1.68, P = 0.003), hypovascularity (HR = 12.62, 95% CI: 1.79-88.92, P = 0.01) and elevated international normalized ratio (HR = 1.46, 95% CI: 1.10-1.92 P = 0.008) are shown to be significant risk factors for increased mortality.

Conclusion: TACE therapy leads to a mean survival of 12 months in patients not receiving orthotopic liver transplantation. Tumour size, hypovascularity on imaging, and elevated international normalized ratio are predictors of increased mortality after TACE therapy for HCC.