Predicting survival in patients with hepatocellular carcinoma treated by transarterial chemoembolisation

Aliment Pharmacol Ther 2011; 34: 196–204

Summary

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 12 months, 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 48 months. 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.