Survival of patients with hepatocellular carcinoma treated by transarterial chemoembolisation (TACE) using Drug Eluting Beads. Implications for clinical practice and trial design

被引:372
作者
Burrel, Marta [1 ]
Reig, Maria [2 ,3 ]
Forner, Alejandro [2 ,3 ]
Barrufet, Marta [1 ]
Rodriguez de Lope, Carlos [2 ]
Tremosini, Silvia [2 ]
Ayuso, Carmen [1 ,3 ]
Llovet, Josep M. [2 ,3 ,4 ,5 ]
Isabel Real, Maria [1 ]
Bruix, Jordi [2 ,3 ]
机构
[1] Univ Barcelona, IDIBAPS, Hosp Clin Barcelona, Radiol Dept,Barcelona Clin Liver Canc BCLC Grp, E-08007 Barcelona, Spain
[2] Univ Barcelona, IDIBAPS, Hosp Clin Barcelona, Liver Unit,Barcelona Clin Liver Canc BCLC Grp, E-08007 Barcelona, Spain
[3] CIBERehd, Barcelona, Spain
[4] Mt Sinai Sch Med, Div Liver Dis, Mt Sinai Liver Canc Program, New York, NY 10029 USA
[5] Inst Catalana Recerca & Estudis Avancats, Barcelona, Catalonia, Spain
关键词
Hepatocellular carcinoma; Chemoembolization; Drug eluting beads (DEB); Safety; Survival; RANDOMIZED CONTROLLED TRIAL; EMBOLIZATION; COHORT;
D O I
10.1016/j.jhep.2012.01.008
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background & Aims: Transarterial chemoembolisation (TACE) improves survival of properly selected patients with hepatocellular carcinoma (HCC). Drug eluting beads (DEB) provide a calibrated and homogenous procedure while increasing efficacy. Outcome data applying this technology is lacking, and this is instrumental for clinical decision-making and for trial design. We evaluated the survival of HCC patients treated with DEB-TACE following a strict selection (preserved liver function, absence of symptoms, extrahepatic spread or vascular invasion). Methods: We registered baseline characteristics, the development of treatment-related adverse events, and the overall survival of all HCC patients treated by DEB-TACE from February 2004 to June 2010. Results: One hundred and four patients were treated with DEB-TACE. All but one were cirrhotic, 62.5% HCV+, 95% Child-Pugh A, 41 BCLC-A and 63 BCLC-B. Causes of DEB-TACE treatment in BCLC-A patients were: 35 unfeasible ablation, and six post-treatment recurrences. After a median follow-up of 24.5 months, 38 patients had died, two patients had received transplantation and 24 had received sorafenib because of untreatable tumour progression. Median survival of the cohort was 48.6 months (95% CI: 36.9-61.2), while it was 54.2 months in BCLC stage A and 47.7 months in stage B. Median survival after censoring follow-up at time of transplant/sorafenib was 47.7 (95% CI: 37.9-57.5) months. Conclusions: These data validate the safety of DEB-TACE and show that the survival expectancy applying current selection criteria and technique is better than that previously reported. A 50% survival at 4 years should be considered when suggesting treatment for patients fitting into controversial scenarios such as expanded criteria for transplantation/resection for multifocal HCC. (C) 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:1330 / 1335
页数:6
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