Survival of patients with hepatocellular carcinoma treated by transarterial chemoembolisation (TACE) using Drug Eluting Beads. Implications for clinical practice and trial design

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• 作者：Marta Burrel¹ ; ^&dagger ; ; Marí ; a Reig² ; ³ ; ^&dagger ; ; Alejandro Forner² ; ³ ; Marta Barrufet¹ ; Carlos Rodrí ; guez de Lope² ; Silvia Tremosini² ; Carmen Ayuso¹ ; ³ ; Josep M Llovet² ; ³ ; ⁴ ; ⁵ ; Marí ; a Isabel Real¹ ; Jordi Bruix² ; ³ ; ^{jbruix@clinic.ub.es}
• 关键词：Hepatocellular carcinoma ; Chemoembolization ; Drug eluting beads (DEB) ; Safety ; Survival
• 刊名：Journal of Hepatology
• 出版年：2012
• 期刊代码：162_01688278
• 类别：med
• 出版时间：June, 2012
• 卷：56
• 期：6
• 页码：1330-1335
• 文件大小：677 K

摘要

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Background & Aims

Transarterial chemoembolisation (TACE) improves survival of properly selected patients with hepatocellular carcinoma (HCC). Drug eluting beads (DEB) provide a calibrated and homogenous procedure while increasing efficacy. Outcome data applying this technology is lacking, and this is instrumental for clinical decision-making and for trial design.

We evaluated the survival of HCC patients treated with DEB-TACE following a strict selection (preserved liver function, absence of symptoms, extrahepatic spread or vascular invasion).

Methods

We registered baseline characteristics, the development of treatment-related adverse events, and the overall survival of all HCC patients treated by DEB-TACE from February 2004 to June 2010.

Results

One hundred and four patients were treated with DEB-TACE. All but one were cirrhotic, 62.5%HCV+, 95%Child-Pugh A, 41 BCLC-A and 63 BCLC-B. Causes of DEB-TACE treatment in BCLC-A patients were: 35 unfeasible ablation, and six post-treatment recurrences. After a median follow-up of 24.5 months, 38 patients had died, two patients had received transplantation and 24 had received sorafenib because of untreatable tumour progression. Median survival of the cohort was 48.6 months (95%CI: 36.9-61.2), while it was 54.2 months in BCLC stage A and 47.7 months in stage B. Median survival after censoring follow-up at time of transplant/sorafenib was 47.7 (95% CI: 37.9-57.5) months.

Conclusions

These data validate the safety of DEB-TACE and show that the survival expectancy applying current selection criteria and technique is better than that previously reported. A 50%survival at 4 years should be considered when suggesting treatment for patients fitting into controversial scenarios such as expanded criteria for transplantation/resection for multifocal HCC.