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Richard R. Lopez, Jr, MD; Shi-Hui Pan, PharmD; Allen L. Hoffman, MD; Carlos Ramirez, MD; Sergio E. Rojter, MD; Hector Ramos, MD; Michael McMonigle, MD; Juan Lois, MD

Arch Surg. 2002;137:653-658.

Hypothesis  Transarterial chemoembolization (TACE) is beneficial for selected patients with unresectable hepatocellular carcinoma (HCC).

Design and Setting  A prospective comparison study in a tertiary hospital.

Study Period  November 21, 1995, to May 2, 2001, with a mean follow-up of 939 days.

Patients  A total of 157 TACE treatments were performed in 88 patients with unresectable HCC: 132 treatments in 69 patients with focal HCC (F-HCC) and 25 treatments in 19 patients with diffuse HCC (D-HCC).

Interventions  Transarterial chemoembolization consisted of selective catheterization and intra-arterial infusion of a mixture of doxorubicin hydrochloride, cisplatin, and mitomycin followed by embolization. Sequential treatments were performed for bilobar HCC.

Main Outcome Measures  Child-Pugh classification and clinical outcomes, including -fetoprotein (AFP) response, length of hospital stay, readmission rate, and survival, were compared between patients with F-HCC and D-HCC following TACE using the ² test, Fisher exact test, or t test (2-tailed, unpaired).

Results  Fifty-eight patients (84%) in the F-HCC group and 18 patients (95%) in the D-HCC group had cirrhosis. For those patients with cirrhosis, 58 (100%) in the F-HCC group and 14 (78%) in the D-HCC group had a Child-Pugh score of A or B (P = .002). The mean baseline AFP was higher in the D-HCC group: 55 577 vs 7815 ng/mL in the F-HCC group (P = .001). Of the patients secreting AFP, 4 (29%) of 14 in the D-HCC group and 30 (68%) of 44 in the F-HCC group had a significant decrease in AFP 1 month following TACE (P = .01). The mean hospital stay was longer (3 vs 1.9 days; P = .001), and readmissions occurred more frequently (44% vs 9%; P<.001) in the D-HCC group. The mean survival rate was significantly higher in the F-HCC group: 425 vs 103 days (P<.001).

Conclusions  In patients with F-HCC, TACE is well tolerated and provides a survival benefit. However, there is no apparent benefit for patients with D-HCC. Importantly, tumor characteristics and hepatic reserve are essential criteria for successful TACE.

From the Comprehensive Liver Disease Center (Drs Lopez, Pan, Hoffman, Ramirez, Rojter, and Ramos) and Department of Radiology (Drs McMonigle and Lois), St Vincent Medical Center, Los Angeles, Calif.

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