Kirstein_2016_Scand.J.Gastroenterol__1

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most lethal cancers. Transarterial chemoembolization (TACE) has been accepted as the standard of care for intermediate stage disease.
METHODS: In this study, we characterized 606 HCC patients from Hannover Medical School treated with TACE.
RESULTS: 606 HCC patients treated with TACE were identified between 2000 and 2015. Most patients (59.8%) were at intermediate stage. Following TACE, most patients subsequently received systemic therapy or best supportive care (BSC), whereas 227 (37.5%) patients were bridged to potentially curative local treatments. Depending on subsequent therapies median post-TACE survival ranged from 7-162 months. Ascites, cholinesterase, c-reactive and alpha-feto protein and tumor size were identified as prognostic factors. These factors as well as the HAP, mHAP-II and STATE score also determined post-TACE survival independent of subsequent therapies. Hepatic function progressively deteriorated with repeated TACE sessions. Despite that, post-TACE survival was not shortened in frequently treated patients (>/=5 times) as compared to patients treated 4 times or less (p = n.s.). Patients treated >/=5 times with TACE received significantly more often systemic therapy following TACE (37.3%) as compared to patients with 3-4(30.1%), 2(27.4%) and 1(21.8%) sessions (p < 0.05). CONCLUSION: TACE is performed in a heterogenous population as bridging therapy to other local treatments and as palliative therapy. The long-term survival following TACE is determined by baseline tumor and patient related factors and by subsequent therapies. Post-TACE survival is not shorter in patients with frequent treatments (>/=5) and the rate of subsequent systemic treatments is higher compared to less frequently treated patients.