Superselective transarterial chemoembolization for hepatocellular carcinoma. Validation of treatment algorithm proposed by Japanese guidelines

Takayasu, Kenichi; Arii, Shigeki; Kudo, Masatoshi; Ichida, Takafumi; Matsui, Osamu; Izumi, Namiki; Matsuyama, Yutaka; Sakamoto, Michiie; Nakashima, Osamu; Ku, Yonson; Kokudo, Norihiro; Makuuchi, Masatoshi

doi:10.1016/j.jhep.2011.10.021

« Previous Next »Journal of Hepatology
Volume 56, Issue 4 , Pages 886-892, April 2012

Superselective transarterial chemoembolization for hepatocellular carcinoma. Validation of treatment algorithm proposed by Japanese guidelines

Kenichi Takayasu
- Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
- Corresponding author. Address: Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan. Tel.: +81 3 3542 2511; fax: +81 3 3542 3815.
- For the Liver Cancer Study Group of Japan.
Shigeki Arii
- Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
- For the Liver Cancer Study Group of Japan.
Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Sayama, Japan
- For the Liver Cancer Study Group of Japan.
Takafumi Ichida
- Department of Hepatology and Gastroenterology, Juntendo Shizuoka Hospital, Izunokuni, Japan
- For the Liver Cancer Study Group of Japan.
Osamu Matsui
- Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
- For the Liver Cancer Study Group of Japan.
Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan
- For the Liver Cancer Study Group of Japan.
Yutaka Matsuyama
- Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan
- For the Liver Cancer Study Group of Japan.
Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
- For the Liver Cancer Study Group of Japan.
Osamu Nakashima
- Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan
- For the Liver Cancer Study Group of Japan.
Yonson Ku
- Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- For the Liver Cancer Study Group of Japan.
Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- For the Liver Cancer Study Group of Japan.
Masatoshi Makuuchi
- Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
- For the Liver Cancer Study Group of Japan.

Received 6 August 2011; received in revised form 15 October 2011; accepted 26 October 2011. published online 14 December 2011.

Background & Aims

Transcatheter arterial chemoembolization with lipiodol (TACE) is widely performed in patients with hepatocellular carcinoma (HCC) unsuitable for curative treatment. It has recently been recommended for patients with 2 or 3 tumors >3cm or ⩾4 tumors in a treatment algorithm proposed by Japanese guidelines. However, the best indication and appropriateness of the algorithm for TACE are still unclear.

Methods

In 4966 HCC patients who underwent TACE, survival was evaluated based on tumor number, size and liver function; and the adequacy of the algorithm for TACE was validated. Exclusion criteria were: vascular invasion, extrahepatic metastasis, and prior treatment. The mean follow up period was 1.6years.

Results

The overall median and 5-year survivals were 3.3years and 34%, respectively. Multivariate analysis revealed that Child–Pugh class, tumor number, size, alpha-fetoprotein, and des-gamma carboxy-prothrombin were independent predictors. The survival rate decreased as the tumor number (p=0.0001) and size increased (p=0.04 to p=0.0001) in all but one subgroup in both Child–Pugh-A and -B. The stratification of these patients to four treatments in the algorithm showed potential ability to discriminate survivals of the resection and ablation (non-TACE) groups from those of the TACE group in Child–Pugh-B and partially in A.

Conclusions

TACE showed higher survival rates in patients with fewer tumor numbers, smaller tumor size, and better liver function. The treatment algorithm proposed by the Japanese guidelines might be appropriate to discriminate the survival of patients with non-TACE from TACE therapy.

Keywords: Hepatocellular carcinoma (HCC), Transcatheter arterial chemoembolization (TACE), Prognostic factor, Validation of treatment algorithm, Japanese guidelines