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Open Access Research article

TACE performed in patients with a single nodule of Hepatocellular Carcinoma

Eleonora Terzi1, Fabio Piscaglia1*, Ludovica Forlani2, Cristina Mosconi2, Matteo Renzulli2, Luigi Bolondi1, Rita Golfieri2 and BLOG-Bologna Liver Oncology Group, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

Author Affiliations

1 Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, Sant’Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy

2 Radiology Unit, Department of Digestive Disease and Internal Medicine, Sant’Orsola-Malpighi General and University Hospital, Bologna, Italy

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BMC Cancer 2014, 14:601  doi:10.1186/1471-2407-14-601

Published: 19 August 2014

Abstract

Background

Patients with single hepatocellular carcinoma (HCC) usually undergo transarterial chemoembolization (TACE) if they are not candidates for curative surgical or ablative therapy. The primary aim of the study was to assess the overall survival and clinical determinants of survival in patients with single HCC who underwent TACE. The secondary aims were tumor response, local and distant recurrence rates, time to recurrence and the impact of TACE on liver function.

Methods

The outcomes of 148 consecutive patients with single HCC who underwent TACE from January 2004 to December 2009 were retrospectively analyzed.

Results

Complete response (CR) was observed in 95/148 (64%) patients and a partial response (PR) in 39 (26%) patients. The recurrence rate was 27%, 42% and 65% at 6, 12 and 24 months, respectively. The day after TACE, 56 (38%) patients had a Child-Pugh increase ≥1 and 93 (63%) had a MELD increase ≥1. Median survival was 36.0 months with 1-, 3- and 5-year survival rates of 85%, 50% and 26%, respectively. Bland portal thrombosis was not seen to have any impact at univariate survival analysis; however, a slight impairment of PS (PS-1) in small tumors had some, although minor, impact on prognosis. Factors associated with shorter survival at multivariate analysis were tumor >5 cm, absence of CR, ascites, alpha-fetoprotein (AFP) ≥14.5 ng/mL and a MELD increase ≥1.

Conclusions

Transarterial chemoembolization is a valid treatment option in patients with single HCC not suitable for curative treatment. Bland PVT has no major impact on survival and a slight impairment of PS attributable to cirrhosis in patients within the Milan criteria should not preclude the use of TACE.

Keywords:
Hepatocellular carcinoma; Transarterial chemoembolization; Tumor radiological response