Severity and Timing of Progression Predict Refractoriness to Transarterial Chemoembolization in Hepatocellular Carcinoma
Journal of Gastroenterology and Hepatology, 05/07/2012Kim HY et al.
Stage progression (SP)–free survival can be regarded as an endpoint for transarterial chemoembolization (TACE) refractoriness. Development of progression or need for three sessions of TACE within the first 6 months could be predictive of TACE refractoriness.
The authors evaluated 264 patients with intermediate-stage HCC who underwent TACE between January 2006 and September 2009.
They designated the development of vascular invasion or extrahepatic spread during follow-up as “stage progression (SP)”, and hypothesized that SP might be the surrogate endpoint for TACE refractoriness.
The median follow-up was 18.2 months, and median number of TACE was 3.0 (range, 1-13).
Median time-to-progression was 5.5 months (95% confidence interval (CI), 4.8-6.2), and median overall survival was 25.3 months (95% CI, 21.6-29.0).
They classified the patients according to disease course as: no progressive disease (PD(-); n=33); PD without SP (PD(+)SP(-); n=113); PD followed by SP (PD --> SP; n=47); and simultaneous PD and SP (PD&SP; n=64).
PD(-) and PD(+)SP(-) groups showed no difference in overall survival, PD-->SP group had worse overall survival than PD(-) and PD(+)SP(-) groups, and PD&SP group had the worst overall survival.
The significant prognostic factors for SP-free survival were development of PD and need for three sessions of TACE during the first 6 months.
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