Clinical outcome of 251 patients with extrahepatic metastasis at initial diagnosis of hepatocellular carcinoma: does transarterial chemoembolization improve survival in these patients?

Yoo, Dong-Jun; Kim, Kang Mo; Jin, Young-Joo; Shim, Ju Hyun; Ko, Gi-Young; Yoon, Hyun-Ki; Sung, Kyu-Bo; Lee, Jae-Lyun; Kang, Yoon-Koo; Lim, Young-Suk; Lee, Han Chu; Chung, Young-Hwa; Lee, Yung Sang; Suh, Dong Jin
Journal of gastroenterology and hepatology
2011Jan ; 26 ( 1 ) :145-54.
저자 상세정보
Yoo, Dong-Jun -
Kim, Kang Mo -
Jin, Young-Joo -
Shim, Ju Hyun -
Ko, Gi-Young -
Yoon, Hyun-Ki -
Sung, Kyu-Bo -
Lee, Jae-Lyun -
Kang, Yoon-Koo -
Lim, Young-Suk -
Lee, Han Chu -
Chung, Young-Hwa -
Lee, Yung Sang -
Suh, Dong Jin -
BACKGROUND AND AIMS: The therapeutic efficacy of transarterial chemoembolization (TACE) has not been evaluated in hepatocellular carcinoma (HCC) patients with extrahepatic metastasis. We investigated the efficacy of TACE with/without systemic chemotherapy (s-chemo) in these patients.

METHODS: We performed a survival analysis of consecutive HCC patients with extrahepatic metastasis, diagnosed at initial presentation according to treatment modality after stratification, using the Child-Pugh classification and intrahepatic HCC T stage, retrospectively.

RESULTS: Between 2005 and 2007, 251 patients were newly diagnosed with HCC involving extrahepatic metastasis at our institution. Among those, 226 were classified as Child-Pugh A-B and the other 25, Child-Pugh C. Within the Child-Pugh A-B group, repeated TACE or transarterial chemoinfusion (TACI) was performed with/without s-chemo in 171 patients. Eight of 226 received s-chemo alone, and 47, conservative management (CM) alone. The median survival time of patients treated with TACE/TACI with s-chemo, TACE/TACI alone, and CM was 10, 5, and 2.9 months in patients classified as Child-Pugh A and T3-stage HCC (TACE/TACI with s-chemo vs CM, P=0.0354; TACE/TACI alone vs CM, P=0.0553) and 7.1, 2.6, and 1.6 months in Child-Pugh B and T3-stage patients, respectively (TACE/TACI with s-chemo vs CM, P=0.0097; TACE/TACI alone vs CM, P<0.0001). Individual treatment with TACE/TACI or sorafenib showed independent prognostic significance in the multivariate analysis. CONCLUSION: Repeated TACE could show significant survival benefits in metastatic HCC patients with conserved liver function and intrahepatic HCC T3 stage. The survival data of our study could be used as a historical control for TACE monotherapy in future clinical trials evaluating combination treatments containing TACE in these patients. CI - ??2010 The Authors; ??2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
hepatocellular carcinoma, metastasis, transarterial chemoembolization, sorafenib, survival analysis
Adolescent, Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols/*therapeutic use, Benzenesulfonates/administration & dosage, Carcinoma, Hepatocellular/drug therapy/mortality/secondary/*therapy, Cause of Death, *Chemoembolization, Therapeutic, Chi-Square Distribution, Female, Humans, Kaplan-Meier Estimate, Liver Neoplasms/drug therapy/mortality/pathology/*therapy, Male, Middle Aged, Neoplasm Staging, Niacinamide/analogs & derivatives, Phenylurea Compounds, Proportional Hazards Models, Protein Kinase Inhibitors/administration & dosage, Pyridines/administration & dosage, Republic of Korea, Retrospective Studies, Risk Assessment, Risk Factors, Survival Rate, Time Factors, Treatment Outcome, Young Adult

주제명(Target field)
연구참여(Sample size)
질병특성(Condition Category)
연구설계(Study Design)
중재방법(Intervention Type)
중재명칭(Intervention Name)
This study indicated that the conventional treatment for intrahepatic HCC, such as repeated TACE/TACI, showed survival benefits compared with conservative management (CM) in HCC patients with extra-hepatic metastasis and preserved liver function, particularly in AJCC/UICC T3-stage intrahepatic HCC patients.
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
ICD 03