Source Diagnostic Radiology, National Cancer Center Hospital.

BACKGROUND: Transcatheter arterial chemoembolization with lipiodol (TACE) is widely performed for patients with hepatocellular carcinoma (HCC) unsuitable for curative treatment, and recently is recommended for those with 2 or 3 tumors >3cm or >= 4 tumors in treatment algorithm proposed by Japanese guidelines. However, the best indication and appropriateness of the algorithm for TACE are still unclear.

PATIENTS AND METHODS: With 4,966 HCC patients who underwent TACE, the survivals were evaluated based on tumor number, size and liver function, and adequacy of algorithm for TACE was validated. Exclusion criteria were vascular invasion, extrahepatic metastasis, and prior treatment. Mean follow-up period was 1.6 years.

RESULTS: The overall median and 5-year survivals were 3.3 years and 34%, respectively. Multivariate analysis revealed Child-Pugh (CP) class, tumor number, size, alpha-fetoprotein, and des-gamma carboxy-prothrombin were independent predictor. The survivals decreased as the tumor number increased (P= 0.0001) and as the tumor size increased in all (P=0.04 to P=0.0001) but one subgroup in both CP-A and B. The stratification of these patients to four treatments in algorithm showed potential to discriminate the survivals of resection and ablation (non-TACE) group from those of TACE group in CP-B and in part in A.

CONCLUSIONS: TACE showed higher survival rates in patients with fewer tumor numbers, smaller tumor size and better liver function. The treatment algorithm proposed by Japanese guideline might be appropriate to discriminate the survival of patients with non-TACE from TACE therapy.