Outcome of transarterial chemoembolization-based multi-modal treatment in patients with unresectable hepatocellular carcinoma

Table 1 Baseline characteristics of the patients n (%)

Variables	All (n = 146)	Treatment group (n = 119)	Conservative group (n = 27)	P value
Age (yr)	52 (30-79)	52 (30-77)	58 (41-79)	0.014
Gender, male	130 (89.0)	111 (93.3)	19 (70.4)	0.002
Etiologies, n				0.385
HBV/HCV/Alcohol/others	115/7/8/16	95/4/7/13	20/3/1/3
AFP (ng/mL)	546.7 (0.7-5719.0)	471.2 (0.7-5719.0)	1210.0 (3.1-2613.0)	0.652
Maximal tumor size (cm)	12.0 (10.0-20.0)	12.0 (10.0-20.0)	11.2 (10.0-17.0)	0.459
Tumor type				0.551
Well-demarcated	99 (67.8)	82 (68.9)	17 (63.0)
Poorly-demarcated	47 (32.2)	37 (31.1)	10 (37.0)
Location of main tumor				0.369
Left	24 (16.4)	18 (15.1)	6 (22.2)
Right	122 (83.6)	101 (84.9)	21 (77.8)
PVT				0.637
Present	108 (74.0)	89 (74.8)	19 (70.4)
Absent	38 (26.0)	30 (25.2)	8 (29.6)
Stage, modified UICC				0.491
Stage III	67 (45.9)	53 (44.5)	14 (51.9)
Stage IV-A	79 (54.1)	66 (55.5)	13 (48.1)

HBV: Hepatitis B virus; HCV: Hepatitis C virus; AFP: Alpha-fetoprotein; PVT: Portal vein thrombosis; UICC: Union for International Cancer Control.

Table 2 Objective response and disease control rate n (%)

	Objective response	Non-response	Disease control	Progressive disease
Treatment group (n = 102)	29 (28.4)	73 (71.6)	60 (58.8)	42 (41.2)
Conservative group (n = 20)	0 (0)	20 (100)	3 (15)	17 (85)
P value	0.003		< 0.001

Evaluation of tumor response was not possible in 17 (14.3% within treatment group) and 7 (25.9%, within conservative group) out of 146 patients.

Table 3 Estimated 6-, 12-, 18- and 24-mo survival rate

	6 mo	12 mo	18 mo	24 mo
Treatment group, total (n = 119)	72.0%	43.0%	28.2%	23.5%
Surgical treatment (n = 17)	88.2%	76.5%	64.7%	64.7%
Localized treatment (n = 102)	69.3%	37.3%	22.0%	16.4%
Conservative group (n = 27)	18.5%	3.7%	0%	0%
P value	< 0.001	< 0.001	< 0.001	< 0.001

Table 4 Pre-treatment prognostic factors for survival in the treatment group

Factors	Univariate analysis			Multivariate analysis
	HR	95%CI	P value	HR	95%CI	P value
Age (< 60 yr vs≥ 60 yr)	0.634	0.393-1.023	0.062
Gender (female vs male)	0.768	0.373-1.584	0.475
Child-Turcotte-Pugh score (5 vs 6)	1.292	0.839-1.990	0.245
AFP (< 1000 ng/mL vs≥ 1000 ng/mL)	1.346	0.914-1.982	0.132
Maximal tumor size (< 15 cm vs≥ 15 cm)	1.342	0.842-2.140	0.216
Tumor type (well-demarcated vs poorly-demarcated)	2.689	1.721-4.203	< 0.001	1.849	1.165-2.934	0.009
Portal vein thrombosis (absent vs present)	2.430	1.519-3.888	< 0.001
Stage (III vs IV-A)	3.344	2.108-5.304	< 0.001	2.828	1.740-4.595	< 0.001

AFP: Alpha-fetoprotein.

Table 5 Treatment-related prognostic factors in the treatment group

Factors	Univariate analysis			Multivariate analysis
	HR	95%CI	P value	HR1	95%CI	P value2
Objective response (present vs absent)	3.591	2.129-6.056	< 0.001	2.87	1.678-4.910	< 0.001
Surgical treatment (yes vs no)	2.9	1.634-5.147	< 0.001	2.301	1.227-4.317	0.009
Multimodality (yes vs no)	1.743	1.198-2.536	0.004	1.835	1.242-2.714	0.002

¹Adjusted HR for tumor type and stage;

²P for adjusted hazard ratio.

Table 6 Comparison of baseline characteristics between the surgical treatment group and the non-surgical treatment group n (%)

Variables	All (n = 119)	Surgical treatment group (n = 17)	Non-surgical treatment group (n = 102)	P value
Age (yr)	52 (30-77)	52 (30-74)	51.5 (32-77)	0.814
Gender, male	111 (93.3)	15 (88.2)	96 (94.1)	0.320
Etiologies (n)				0.704
HBV/HCV/Alcohol/others	95/4/7/13	12/1/1/3	83/3/6/10
AFP (ng/mL)	471.2 (0.7-5719.0)	261.8 (0.7-5719.0)	603.6 (1.9-5102.0)	0.879
Maximal tumor size (cm)	12 (10.0-20.0)	12(10.0-16.0)	12 (10.0-20.0)	0.904
Tumor type				0.051
Well-demarcated	82 (68.9)	15 (88.2)	67 (65.7)
Poorly-demarcated	37 (31.1)	2 (11.8)	35 (34.3)
Location of main tumor				0.085
Left	18 (15.1)	5 (29.4)	13 (12.7)
Right	101 (84.9)	12 (70.6)	89 (87.3)
PVT				0.094
Present	89 (74.8)	10 (58.8)	79 (77.5)
Absent	30 (25.2)	7 (41.2)	23 (22.5)
Stage, modified UICC				0.071
Stage III	53 (44.5)	11 (64.7)	42 (41.2)
Stage IV-A	66 (55.5)	6 (35.3)	60 (58.8)

HBV: Hepatitis B virus; HCV: Hepatitis C virus; AFP: Alpha-fetoprotein; PVT: Portal vein thrombosis; UICC: Union for International Cancer Control.