Prognostic Factors For Patients With Hepatocellular Carcinoma (BCLC C Stage) Who Received Transarterial Chemoembolization

Background:The Barcelona Clinic Liver Cancer (BCLC) staging system is commonly accepted as a guideline for Hepatocellular Carcinoma (HCC) treatment. According to BCLC staging system, patients with intermediate HCC (BCLC B stage) are recommended to receive Trans-Arterial Chemo-Embolization (TACE), and patients with advanced HCC (BCLC C stage) are recommended to receive sorafenib treatment. But there is no conform evidence support that sorafenib would be better than TACE. In our clinical practice, many patients with advanced HCC (BCLC C stage) who received TACE have an ideal survival benefit. So find the prognostic factors for patients with advanced HCC (BCLC C stage) who received TACE and compare the efficacies of TACE and sorafenib in patients with advanced-stage primary liver carcinoma is important for our clinical practice.Purpose:To find the prognostic factors for patients with advanced HCC (BCLC C stage) who received TACE and to compare the efficacies of TACE and sorafenib in patients with advanced-stage HCC.Method:We retrospectively studied652HCC patients who were admitted in Liver Caner Institute of Zhongshan Hospital between January2007and December2011.All of the652patients received TACE treatment. Factors determining survival were analyzed by univariate and multivariate analysis using the Kaplan-Meier method and Cox Proportional hazard regression models. All the data were analyzed with SPSS19.0software.Results::At the end of follow-up,294patients(45.09%) were deceased. Overall median survival was10.54months, with estimated6months,1-,2-,and3year survival rates as60%、45%、32%、27%, respectively. By univariate Kaplan-Meier method analysis, ALT、AFP、GGT、ALB、ascites、Child-Pugh rank、tumor size、tumor numbers、thromb、distant metastasis、clinical stage、complications、times of treatment are the factors may affect the prognosis of HCC patients with advanced HCC (BCLC C stage), By multivariate Cox regression analysis, AFP、GGT、tumor size、clinical stage、complications、thromb、times of treatment are independent prognostic factors for overall survival. After comparing with SHARP and ORIENTAL study, we conclude that TACE might be a better choice for patients with advanced HCC (BCLC C stage).Conclusion:We recommend patients with advanced HCC (BCLC C stage) who meet the following conditions receive TACE treatment:AFP<1000ng/ml、 GGT<200U/L、clinical stage I、tumor size within5cm、no thromb. Patients with distant metastasis cancer can also receive TACE treatment if their liver function is good. Avoid complications during doing the treatment and balance the times and interval of treatment is also important of survival benefit.