Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2015; 21(8): 2395-2404
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2395
Outcome of transarterial chemoembolization-based multi-modal treatment in patients with unresectable hepatocellular carcinoma
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jin Dong Kim, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Young Joon Lee, Ho Jong Chun, Young Kyoung You, Jong Young Choi, Seung Kew Yoon
Do Seon Song, Soon Woo Nam, Si Hyun Bae, Jeong Won Jang, Myeong Jun Song, Sung Won Lee, Hee Yeon Kim, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea
Jin Dong Kim, Department of Internal Medicine, Cheju Halla General Hospital, Jeju 690-766, South Korea
Young Joon Lee, Ho Jong Chun, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea
Young Kyoung You, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea
Author contributions: Bae SH and Kim JD designed the research; Jang JW, Song MJ, Lee SW, Kim HY, Lee YJ, Chun HJ, You YK, Choi JY, and Yoon SK performed the research; Song DS and Kim JD analyzed the data; Song DS and Nam SW wrote the paper.
Supported by National R & D Program grant for cancer control from the Ministry of Health, Welfare and Family Affairs, South Korea, No. R0620390-1.
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: Soon Woo Nam, MD, PhD, Associate Professor, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, South Korea. drswnam@hanmail.net
Telephone: +82-2-22582073 Fax: +82-2-34814025
Received: August 8, 2014
Peer-review started: August 9, 2014
First decision: September 15, 2014
Revised: October 3, 2014
Accepted: November 19, 2014
Article in press: November 19, 2014
Published online: February 28, 2015
Processing time: 204 Days and 6.6 Hours
Abstract

AIM: To investigate the efficacy and safety of transarterial chemoembolization (TACE)-based multimodal treatment in patients with large hepatocellular carcinoma (HCC).

METHODS: A total of 146 consecutive patients were included in the analysis, and their medical records and radiological data were reviewed retrospectively.

RESULTS: In total, 119 patients received TACE-based multi-modal treatments, and the remaining 27 received conservative management. Overall survival (P < 0.001) and objective tumor response (P = 0.003) were significantly better in the treatment group than in the conservative group. After subgroup analysis, survival benefits were observed not only in the multi-modal treatment group compared with the TACE-only group (P = 0.002) but also in the surgical treatment group compared with the loco-regional treatment-only group (P < 0.001). Multivariate analysis identified tumor stage (P < 0.001) and tumor type (P = 0.009) as two independent pre-treatment factors for survival. After adjusting for significant pre-treatment prognostic factors, objective response (P < 0.001), surgical treatment (P = 0.009), and multi-modal treatment (P = 0.002) were identified as independent post-treatment prognostic factors.

CONCLUSION: TACE-based multi-modal treatments were safe and more beneficial than conservative management. Salvage surgery after successful downstaging resulted in long-term survival in patients with large, unresectable HCC.

Keywords: Hepatocellular carcinoma; Multimodal treatment; Transarterial chemoembolization; Salvage surgery

Core tip: The aim of this study was to investigate the efficacy of transarterial chemoembolization (TACE)-based multimodal treatment in patients with large hepatocellular carcinoma. The primary findings of this study were as follows: (1) The overall survival was significantly longer in the treatment group than in the conservative group; (2) Survival benefits were observed not only in the surgical treatment group (TACE + resection or transplantation) compared with the localized treatment group (TACE + ablation/radiotherapy) but also in the combination treatment group compared with the TACE-only group; and (3) Objective response, surgical treatment, and multi-modality were independent factors for survival.