THE ROLE OF TRANSARTERIAL CHEMOEMBOLIZATION IN THE TREATMENT OF HEPATOCELLULAR CARCINOMA IN THE STAGE B OF BCLC

Abstract

Hepatocellular carcinoma is the most common primary tumor pathology of the liver (> 85%), an aggressive course with an unfavorable prognosis. Objective: To analyze the results of transarterial chemoembolization in the intermediate stage of hepatocellular carcinoma. Materials and methods: The study was conducted on the basis of the JSC “National Scientific Center of Surgery” named after A.N. Syzganov in the period 2013-2018. Statistical calculations were performed using Excel, SPSS Statistics by estimating the survival rate using the Kaplan-Meier method. Results: The study included 58 patients with HCC in the B stage of BCLC. The average age of the patients was 60.4 years. The follow-up period was 6–64 months. In 42 patients, the test results for viral hepatitis were positive. 58 patients underwent 103 TACE interventions. After chemoembolization, 8 patients subsequently underwent surgery (liver resection). The one-year survival after TACE in the total cohort was 42%, 2-year - 15% and 3-year - 5%, respectively. In patients older than 60 and 70 years, the 3-year and 5-year survival rates were 0%, the one-year survival rate of the subjects studied in the group over 70 years old was 14.3%. The survival rate among patients in stage B on the Chile-Pugh scale was significantly lower to patients in stage A (82% versus 56% for 6 months and 50% versus 31% for the year, respectively). Statistically significant differences were found in the group with a substantial increase in AFP (> 1000 IU / ml), the Kaplan-Meier survival curve showed a survival rate of 0% after 18 months since the first TACE. Six months after TACE contrast enhanced CT was performed on 36 patients, of which 15 patients showed positive dynamics, in the form of a reduction in size or transformation of the formation, in 6 patients a negative dynamics in the form of an increase in the size of the formation. Conclusion: Despite the small number of patients studied, TACE showed good results in the intermediate stage of HCC. Elderly and senile age, a high degree of liver dysfunction, as well as high AFP values are additional factors that dramatically reduce the life expectancy of patients after TACE with HCC in stage B-BCLC.