Retrospective Cohort Study
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World J Gastroenterol. Jul 7, 2014; 20(25): 8158-8165
Published online Jul 7, 2014. doi: 10.3748/wjg.v20.i25.8158
Hepatocellular carcinoma treated by conventional transarterial chemoembolization in field-practice: Serum sodium predicts survival
Marco Biolato, Luca Miele, Vittoria Vero, Simona Racco, Carmine Di Stasi, Roberto Iezzi, Andrea Zanché, Maurizio Pompili, Gian Ludovico Rapaccini, Giuseppe La Torre, Antonio Gasbarrini, Antonio Grieco
Marco Biolato, Luca Miele, Vittoria Vero, Simona Racco, Andrea Zanché, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Gasbarrini, Antonio Grieco, Department of Internal Medicine, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, 00168 Rome, Italy
Carmine Di Stasi, Roberto Iezzi, Department of Radiology, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, 00168 Rome, Italy
Giuseppe La Torre, Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy
Author contributions: Grieco A, Miele L, Vero V and Biolato M designed the research; Vero V, Racco S, Di Stasi C, Iezzi R and Zanché A performed the research; Biolato M, Miele L, La Torre G and Grieco A analyzed the data; Biolato M wrote the paper and Pompili M, Rapaccini GL, Gasbarrini A critically revised the manuscript for important intellectual content.
Correspondence to: Antonio Grieco, MD, Professor of Medicine, Hepatology Unit, Department of Internal Medicine, Policlinico Gemelli Hospital and Catholic University of the Sacred Heart, Largo Agostino Gemelli n 8, 00168 Rome, Italy. agrieco@rm.unicatt.it
Telephone: +39-6-30155451 Fax: +39-6-35502775
Received: December 10, 2013
Revised: February 7, 2014
Accepted: March 8, 2014
Published online: July 7, 2014
Processing time: 204 Days and 21.4 Hours
Abstract

AIM: To assess the prognostic role of baseline clinical, biochemical and radiological characteristics of patients with hepatocellular carcinoma (HCC) treated with the first transarterial chemoembolization (TACE) procedure.

METHODS: Patients with HCC treated with conventional TACE in a tertiary care setting from 1997 to 2008 were retrospectively reviewed. Predictors of survival were identified using the Cox proportional regression model.

RESULTS: Two hundred and seventy patients were included. Median age was 66 years, 81% were male, 58% were HCV-positive, 18% hepatitis B surface antigen-positive, 64% had a Child A status, 40% patients had a largest nodule diameter ≥ 5 cm and 32% had more than 3 tumor nodules. Median overall survival of the whole cohort was 25 mo (95%CI: 21.8-28.2) and the 1-, 2- and 3-year probability of survival was 80%, 50% and 31%, respectively. Non-tumor segmental portal vein thrombosis (HR = 1.76, 95%CI: 1.22-2.54), serum sodium (HR = 1.65, 95%CI: 1.25-2.18), diameter of largest nodule (HR = 1.59, 95%CI: 1.22-2.091), number of nodules (HR = 1.41, 95%CI: 1.06-1.88), alpha-fetoprotein (HR = 1.35, 95%CI: 1.03-1.76) and alkaline phosphatase (HR = 1.33, 95%CI: 1.01-1.74) were independent prognostic factors for overall survival on multivariate analysis.

CONCLUSION: The inclusion of serum sodium alongside the already known prognostic factors may allow a better prognostic definition of patients with HCC as candidates for conventional TACE.

Keywords: Liver cancer; Sorafenib; Hyponatremia; Model for end-stage liver disease sodium; Chemoembolization

Core tip: This work describes, in a retrospective cohort of 270 patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (TACE) at our institution, the prognostic role of baseline clinical, biochemical and radiological characteristics of patients. Besides well-known prognostic parameters like portal vein thrombosis, nodule diameter and number of lesions, this study underlines the independent prognostic role of serum sodium, a well-known prognostic parameter in the field of liver cirrhosis, but less investigated in the field of hepatocellular carcinoma. Our study is the first to document the prognostic role of serum sodium in patients with HCC treated with TACE in a Western center.