Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with cirrhosis: evaluation of two kinds of dosages of anticancer drugs and analysis of prognostic factors

Wei Lu, Yanhao Li, Xiaofeng He, Yong Chen
Hepato-gastroenterology 2003, 50 (54): 2079-83

BACKGROUND/AIMS: To evaluate the efficacy of TACE (transcatheter arterial chemoembolization) with use of low-dose versus conventional-dose anticancer drugs in hepatocellular carcinoma patients with cirrhosis and to analyze their prognostic factors.

METHODOLOGY: Eight-two patients with unresectable hepatocellular carcinoma underwent super-selective TACE. Patients in group A (n = 40) received low-dose anticancer drugs. Patients in group B (n = 42) were given conventional-dose of anticancer drugs. Tumor response and survival time in the two groups were compared. Cox proportion-hazards modeling was used to evaluate the relative importance of prognostic variables.

RESULTS: There was no significant difference between the two groups in initial tumor response (P < 0.05). The median survival in all patients was 18 months (mo). The median survival in groups A and B were 20 mo and 16 mo respectively. The cumulative survival rates at 6, 12, 18, 24, 30 mo were 68.4%, 57.6%, 38.4%, 26.6%, 19.9% in group A, and 62.6%, 43.8%, 31.9%, 26.5%, 26.5% in group B. There was no significant difference in survival between the two groups (P > 0.05). The factors influencing prognosis were Child-Pugh scores (P < 0.0001), tumor thrombus in the portal vein (P < 0.0001), tumor size (P < 0.0001), method of embolization (P < 0.0001), TACE times (P < 0.001). The dosage of anticancer drugs employed in TACE was not relevant to the survival rates (P = 0.883).

CONCLUSIONS: TACE with use of large-dose anticancer drugs does not significantly enhance the anticancer effects and survival compared that with lowdose anticancer drugs. The therapeutic effect of TACE was mainly attributed to embolization of the artery rather than to anticancer drugs.

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