Analysis of Recurrence and Prognostic Factors after Transarterial Chemoembolization in Patients with Hepatocelular Carcinoma

Geum, Min Su; Kim, Dae Hyun; Tak, Won Young; Kweon, Young Oh; Kim, Sung Kook; Choi, Yong Hwan; Chung, Joon Mo

Abstract

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is a malignant tumor with very poor prognosis if left untreated after diagnosis. However, recent advances in digital subtraction imaging techniques and superselective catheterization seem to have somewhat increased the survival rate in patients with HCC after transarterial chemoembolization (TACE). This study analyzed the relationship between prognostic factors and recurrence after TACE, an aspect which has not attracted much attention.
METHODS
This investigation included 258 cases of HCC with 100% lipiodol uptake who received TACE for a duration of 13 years from 1985 to 1997. Clinical characteristics, biochemical factors, tumoral factors, angiographic characteristics, embolization technique, degree of lipiodol uptake, response, and recurrence factors were analyzed retrospectively.
RESULTS
Significant differences in survival were noted among 3 groups according to cancer-free interval (p<0.01). The different factors between early recurrence group (within 6 months) and late recurrence group (after 18 months) were initial tumor size (8.8+/-4.1/6.1+/-3.7cm, p<0.01), tumor type (multinodular,massive/single nodule, p<0.01), ill-defined margin (51.4/22.0%, p<0.01), response after TACE (NC/CR,PR, p<0.01), ALP level (196.1+/-124.5/144.4+/-72.0 IU/L, p<0.05), absence of encapsulation (42.3/25.0%, p<0.05), portal vein thrombosis (64.3/14.3%, p<0.05), nonsegmental embolization (46.6/25.0%, p<0.05), post-TACE AFP level (180.5+/-252.1/76.6+/-329.8 ng/mL, p<0.05), and recurrence pattern (revascularization of initial lesion/single nodule, p<0.05).
CONCLUSIONS
Recurrence factors were significant in the survival of patients with HCC after TACE. Therefore, an understanding of the relationship between prognostic factors and recurrence is very important for early detection of recurrence and the timely provision of further TACE treatment.