Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2015; 21(29): 8888-8893
Published online Aug 7, 2015. doi: 10.3748/wjg.v21.i29.8888
Transcatheter arterial infusion for advanced hepatocellular carcinoma: Who are candidates?
Eiichiro Suzuki, Tetsuhiro Chiba, Yoshihiko Ooka, Sadahisa Ogasawara, Akinobu Tawada, Tenyu Motoyama, Naoya Kanogawa, Tomoko Saito, Masaharu Yoshikawa, Osamu Yokosuka
Eiichiro Suzuki, Tetsuhiro Chiba, Yoshihiko Ooka, Sadahisa Ogasawara, Akinobu Tawada, Tenyu Motoyama, Naoya Kanogawa, Tomoko Saito, Masaharu Yoshikawa, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
Author contributions: Suzuki E, Ooka Y and Ogasawara S designed the research; Tawada A, Motoyama T and Kanogawa N performed the research and acquisition of data; Suzuki E, Ooka Y, Saito T and Yoshikawa M contributed to analysis and interpretation of data; Suzuki E and Chiba T performed the statistical analysis and wrote the manuscript; Yokosuka O supervised the study.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Chiba University.
Informed consent statement: Written informed consent was obtained from all study participants prior to study enrollment.
Conflict-of-interest statement: Professor Osamu Yokosuka received grant support (scholarship contribution) from Dainippon Sumitomo Pharma Co, Ltd (Osaka, Japan) and Nippon Kayaku Co, Ltd (Tokyo, Japan). The remaining authors disclose no conflicts.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at techiba@faculty.chiba-u.jp. Participants gave informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tetsuhiro Chiba, MD, PhD, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. techiba@faculty.chiba-u.jp
Telephone: +81-43-2262083 Fax: +81-43-2262088
Received: January 15, 2015
Peer-review started: January 16, 2015
First decision: March 10, 2015
Revised: March 26, 2015
Accepted: May 4, 2015
Article in press: May 4, 2015
Published online: August 7, 2015
Abstract

AIM: To elucidate anticancer effects of transcatheter arterial infusion chemotherapy (TAI) in patients with hepatocellular carcinoma (HCC).

METHODS: Data from a total of 95 patients with HCC who received TAI were analyzed retrospectively. The efficacy of TAI was evaluated according to the Response Evaluation Criteria in Cancer of the Liver. Overall survival was calculated from the date of initial treatment to the date of death or last follow-up. Survival curves were calculated by the Kaplan-Meier method, and differences in survival were evaluated by the log rank test. Clinical variables that were identified as statistically different by a univariate analysis were included into the Cox proportional hazard regression model for multivariate analysis. A prognostic index based on the regression coefficients derived from variables identified by the multivariate analysis was constructed. Stratification of the patients was conducted using this prognostic index.

RESULTS: The patient group was comprised of 76 men and 19 women with an average age of 68 years (range: 37-82 years). Six patients (6.3%) showed complete response and 18 patients (18.9%) showed partial response, for an overall response rate of 25.2%. The median overall survival was 27.6 mo, and the proportions of survivors at 1, 2, and 5 years were 67.4%, 54.0%, and 17.4%, respectively. Multivariate analysis demonstrated that no prior transcatheter arterial chemoembolization, lactate dehydrogenase < 230 IU/L, and performance status of 0 were the independent favorable prognostic factors. The development of a 0-3-point prognostic score index was based on the sum of these three prognostic factors. Subsequently, the patients were categorized into three groups: those with a good (prognostic index = 0-1; n = 54), intermediate (prognostic index = 2; n = 26), or poor (prognostic index = 3; n = 15) prognosis. The median survival times in these three groups were 41.0, 21.2, and 6.8 mo, respectively (P < 0.01).

CONCLUSION: Our simple prognostic index may be helpful for management of patients in determining treatment strategies for advanced HCC in the era of molecularly targeted therapy.

Keywords: Hepatocellular carcinoma, Interventional radiology, Prognostic factor, Survival, Transcatheter arterial infusion

Core tip: Transcatheter arterial infusion chemotherapy is one of the therapeutic approaches for hepatocellular carcinoma. In this study, multivariate Cox regression analyses demonstrated that no prior transcatheter arterial chemoembolization, lactate dehydrogenase < 230 IU/L, and performance status of 0 were the independent favorable prognostic factors. The prognostic index based on a combination of these three prognostic factors successfully categorized the patients into three groups with good, intermediate, or poor prognoses. This index may assist in the prediction of response to transcatheter arterial infusion chemotherapy in patients with hepatocellular carcinoma.