Risk factors and therapeutic results of early local recurrence after transcatheter arterial chemoembolization

Table 1 Baseline patient characteristics n (%)

Characteristic	Total patients, n = 134
Male sex	89 (66.4)
Age, yr, mean ± SD	63.1 ± 10.4
Etiology of primary hepatic tumor
Viral hepatitis B infection	73 (54.5)
Viral hepatitis C infection	24 (17.9)
Alcohol consumption	22 (16.4)
Others	9 (6.7)
Viral infection + alcohol consumption	6 (4.5)
Decompensated cirrhosis	51 (38.1)
Child-Pugh class (A/B/C)	93 (69.4)/39 (29.1)/2 (1.5)
Portal hypertension (present)	93 (69.4)
Tumor related characteristics
Tumor maximal diameter, median (range)	2.6 (1.0-12.7)
Tumor number (single/multiple)	88 (65.7)/46 (34.3)
Portal vein thrombosis (present)	9 (6.7)
Well defined/infiltrating	131 (97.8)/3 (2.2)
Ruptured HCC	4 (3.0)
Tumor staging (AJCC 7th edition)
Stage I	84 (62.7)
Stage II	36 (26.9)
Stage IIIA/IIIB/IIIC	7 (5.2)/5 (3.7)/-
Stage IVA/IVB	-/2 (1.5)
Laboratory finding
Total bilirubin, mg/dL, median (range)	0.90 (0.20-5.20)
Prothrombin time, s, mean ± SD	13.41 ± 2.10
Albumin, mg/dL, mean ± SD	3.61 ± 0.53
TACE no. to CR (1/2/3/≥ 4)	107/19/5/3 (79.9/14.2/3.7/2.2)

AJCC: American Joint Committee on Cancer; HCC: Hepatocellular carcinoma; SD: Standard deviation; TACE: Transcatheter arterial chemoembolization; CR: Complete response.

Table 2 Univariate and multivariate analysis of factors significantly predictive of early local recurrence after achieving a complete response

Variable	Univariate analysis			Multivariate analysis
	OR	95%CI	P value	OR	95%CI	P value
Age (≥ 65 yr)	0.489	0.233-1.026	0.058	-	-	-
Sex (female)	2.239	1.028-4.876	0.042	1.969	0.704-5.507	0.197
Tumor number, multiple	2.614	1.203-5.680	0.015	2.171	0.784-6.012	0.136
Tumor size (cm)
2-5	3.107	1.318-7.324	0.010	3.911	1.344-11.383	0.012
> 5	9.000	2.401-33.738	0.001	5.218	1.056-25.767	0.043
Child-Pugh score (≥ 8)	2.773	0.785-9.788	0.113	-	-	-
Decompensated LC	0.830	0.385-1.788	0.634	-	-	-
Gelfoam or PVA use	1.487	0.662-3.340	0.336	-	-	-
Bilirubin (> 2.0 mg/dL)	3.351	0.623-18.030	0.159	-	-	-
Albumin (< 3.5 mg/dL)	1.550	0.732-3.284	0.252	-	-	-
Post-CR AFP (> 20 ng/mL)	2.362	1.023-5.456	0.044	3.464	1.262-9.507	0.016
Lipiodol uptake (non-compact)	9.342	2.916-29.929	< 0.001	9.092	2.537-32.508	0.001
TACE number to CR (≥ 2)	2.765	1.105-6.924	0.030	2.029	0.715-5.756	0.715

AFP: α-fetoprotein; CR: Complete response; OR: Odds ratio; LC: Liver cirrhosis; PVA: Polyvinyl alcohol; TACE: Transcatheter arterial chemoembolization; PVT: Portal vein thrombosis.

Table 3 Complications from the chemoembolization procedure n (%)

Complication	Frequency per 523 procedures
Postembolization syndrome	434 (83.0)
Fever	305 (58.3)
Abdominal pain	326 (62.3)
Nausea/vomiting	135 (25.8)/26 (5.0)
Acute hepatic failure	110 (21.0)
Reversible/Irreversible	91 (17.4)/19 (3.6)
Biloma	6 (1.1)
Liver abscess	5 (1.0)
Septicemia	6 (1.1)
Acalculous cholecystitis	2 (0.4)
Diarrhea, simple/infectious (including PMC)	22 (4.2)/3 (0.6)
Headache	83 (15.9)
Dizziness	15 (2.9)
Itching sense	24 (4.6)
Acute urticaria, drug eruption, skin rash	6 (1.1)
Local bleeding (including rebleeding, hematoma)	5 (1.0)
Upper GI bleeding, total	11 (2.1)
Esophageal varix bleeding	4 (0.8)
Gastric varix bleeding	2 (0.4)
Ulcer bleeding	4 (0.8)
Mallory-Weiss tear	1 (0.2)
Others
Splenic infarction	1 (0.2)
Stress-induced cardiomyopathy	1 (0.2)
Paralytic ileus	1 (0.2)
Skin necrosis	1 (0.2)

PMC: Pseudomembranous colitis; GI: Gastrointestinal.