[Transcatheter arterial embolization of unresectable hepatocellular carcinoma: does selective treatment improve outcome?].

Abstract

Purpose: To evaluate whether selective transcatheter arterial embolization (TAE) contributes to preservation of liver function and improves local control and survival in patients with hepatocellular carcinoma.

Materials and methods: One hundred patients with hepatocellular carcinoma who underwent single or multiple TAE were retrospectively analyzed. The incidence of deterioration of liver function caused by TAE was compared between patients with Child class A disease and those having Child B/C disease. The correlation between extent of embolization and incidence of deterioration of liver function was analyzed. In addition, factors affecting deterioration of liver function after TAE were determined. Recurrence-free and overall survival rate were calculated using the Kaplan-Meier method. A Cox proportional hazard model was used to analyze prognostic factors affecting recurrence-free and overall survival.

Results: The incidence of deterioration of liver function in the Child B/C group (47%) was significantly higher than that in the Child A group (21%). Pretreatment Child-Pugh classification and extent of embolization were significant factors in the deterioration of liver function after TAE. Recurrence-free survival rates at 1, 2, and 3 years were 38%, 19%, and 8%, respectively. Overall survival rates at 1, 3, 5, and 7 years were 89%, 59%, 22%, and 22%, respectively. Findings of multivariate analyses of prognostic factors showed that tumor size and selectivity of TAE were significant for recurrence-free survival and the initial Child-Pugh classification was the most important factor for overall survival.

Conclusion: Selective TAE improves local control and avoids damage to nontumorous liver tissue. The selective technique appears to be associated with a favorable outcome.