Hepatocellular carcinoma treated by conventional transarterial chemoembolization in field-practice: serum sodium predicts survival

Abstract

Aim: To assess the prognostic role of baseline clinical, biochemical and radiological characteristics of patients with hepatocellular carcinoma (HCC) treated with the first transarterial chemoembolization (TACE) procedure.

Methods: Patients with HCC treated with conventional TACE in a tertiary care setting from 1997 to 2008 were retrospectively reviewed. Predictors of survival were identified using the Cox proportional regression model.

Results: Two hundred and seventy patients were included. Median age was 66 years, 81% were male, 58% were HCV-positive, 18% hepatitis B surface antigen-positive, 64% had a Child A status, 40% patients had a largest nodule diameter ≥ 5 cm and 32% had more than 3 tumor nodules. Median overall survival of the whole cohort was 25 mo (95%CI: 21.8-28.2) and the 1-, 2- and 3-year probability of survival was 80%, 50% and 31%, respectively. Non-tumor segmental portal vein thrombosis (HR = 1.76, 95%CI: 1.22-2.54), serum sodium (HR = 1.65, 95%CI: 1.25-2.18), diameter of largest nodule (HR = 1.59, 95%CI: 1.22-2.091), number of nodules (HR = 1.41, 95%CI: 1.06-1.88), alpha-fetoprotein (HR = 1.35, 95%CI: 1.03-1.76) and alkaline phosphatase (HR = 1.33, 95%CI: 1.01-1.74) were independent prognostic factors for overall survival on multivariate analysis.

Conclusion: The inclusion of serum sodium alongside the already known prognostic factors may allow a better prognostic definition of patients with HCC as candidates for conventional TACE.

Keywords: Chemoembolization; Hyponatremia; Liver cancer; Model for end-stage liver disease sodium; Sorafenib.

Figure 1

Kaplan-Meier analysis of overall survival. A: Among 270 patients, the median overall survival was 25 mo (95%CI: 21.8-28.2); B: According to baseline serum sodium (105 patients with serum sodium < 138 mEq/L and 163 patients with serum sodium ≥ 138 mEq/L): median overall survival was respectively 19 mo (95%CI: 15.4-22.1) and 26 mo (95%CI: 21.8-30.2); hazard ratio for death in the serum sodium < 138 mEq/L group 1.65 (95%CI: 1.25-2.18).