Survival benefit of transarterial chemoembolization in patients with metastatic hepatocellular carcinoma: a single center experience

Abstract

Background: As prognosis of patients with metastatic hepatocellular carcinoma (HCC) is mainly determined by intrahepatic HCC progression, local treatment with TACE may result in improved OS, although it is not recommended. The purpose of this study was to analyze retrospectively the efficacy of TACE and its impact on OS in patients with metastatic hepatocellular carcinoma (HCC).

Methods: Two hundred and fifteen patients with metastatic HCC who were treated at our Liver Center between 2003 and 2014 were included in this retrospective analysis. Medical records, laboratory parameters and imaging studies were analyzed. Treatment of metastatic HCC and OS were assessed RESULTS: One hundred and two patients (47.4%) did not receive any HCC specific treatment while 48 patients (22.3%) were treated with sorafenib, 42 patients (19.5%) with TACE and 23 patients (10.7%) received treatment with TACE and sorafenib in combination. Survival analyses and Cox regression models revealed that TACE and a combination therapy of TACE and sorafenib were significant prognostic factors in metastatic HCC. However, further analyses revealed that there was no additional prognostic effect of adding sorafenib to TACE treatment in this patient cohort.

Conclusions: In metastatic HCC, treatment of intrahepatic tumor by TACE may be associated with improved survival. These results support the prognostic importance of treating intrahepatic HCC even in patients with metastatic disease. Therefore, we suggest evaluating the technical feasibility of TACE in all metastatic patients.

Keywords: Hepatocellular carcinoma; Metastases; Prognosis; Sorafenib; Transarterial chemoembolization.

Fig. 1

Liver function assessed by the ALBI score in patients with no HCC specific treatment compared to patients with different treatment approaches. Patients who did not receive any HCC specific treatment had impaired liver function as shown by a higher ALBI grade. * The group “HCC treatment” includes all patients who received either sorafenib, TACE or a combination of both

Fig. 2

Patients who did not receive any HCC specific treatment had worst median OS of 3 months compared to patients who were treated with sorafenib (6 months, p = 0.009), with TACE (9 months, p < 0.001) and to those treated with a combination of TACE and sorafenib (16 months, p = 0.002)