Predicting survival in patients with hepatocellular carcinoma treated by transarterial chemoembolisation.

ABSTRACT

BACKGROUND: Transarterial chemoembolisation (TACE) is first-line treatment in unresectable hepatocellular carcinoma (HCC) and rescue treatment after failure of radical treatments in early stage HCC. Prognostic tools for HCC using time-fixed Cox models may be unreliable in patients treated with TACE because time-varying predictors interact. AIM: To explore time-dependent variables as survival predictors in patients with HCC receiving TACE as first-line or second-line treatment. METHODS: Eighty four consecutive patients with HCC (mean age 68; male gender 62%; Child-Pugh class A n=73, B n=11; Barcelona Clinic Liver Cancer class A n=44, B n=24, C n=16) treated with TACE were enrolled. Clinical, laboratory and radiological follow-up data were collected from the time of first treatment. Time-fixed and time-dependent Cox analyses were done. RESULTS: Overall survival rates were 89.6% (95% CI 82.5-97.2) at 12months, 58.8% (95% CI 46.2-74.9) at 24, 35.4% (95% CI 22.3-56.1) at 36 and 17.2% (95% CI 7.0-41.7) at 48months. Performance status (P<0.001), number of nodules (P<0.016) and prior therapy (P=0.017) were the only variables strongly linked to survival by time-fixed Cox model. Performance status (P<0.001), prior therapy (P=0.005), number of treatments (P=0.013), complete response after TACE (P=0.005) and bilirubin level (P<0.001) were associated with survival using a time-dependent Cox model. CONCLUSIONS: Survival after TACE is influenced most by performance status, complete response and bilirubin. Compared with the time-fixed models, a time-dependent Cox model has the potential to estimate a more precise prognosis in HCC patients treated with TACE.