Abstract

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 timedependent Cox model has the potential to estimate a more precise prognosis in HCC patients treated with TACE.
Original languageEnglish
Pages (from-to)196-204
Number of pages9
JournalALIMENTARY PHARMACOLOGY & THERAPEUTICS SUPPLEMENT
Volume34
Publication statusPublished - 2011

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Survival
Proportional Hazards Models
Bilirubin
Therapeutics
Liver Neoplasms
Treatment Failure
Survival Rate
Carcinoma

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Pharmacology (medical)
  • Gastroenterology

Cite this

@article{fc1b1a5606ff4ba6b62bf6496d79b55b,
title = "Predicting survival in patients with hepatocellular carcinoma treated by transarterial chemoembolisation",
abstract = "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 timedependent Cox model has the potential to estimate a more precise prognosis in HCC patients treated with TACE.",
keywords = "TACE, HCC",
author = "Antonio Craxi and {Di Marco}, Vito and Calogero Camma' and Giuseppe Brancatelli and Giuseppe Cabibbo and Chiara Genco and Marco Enea and Camm{\`a}",
year = "2011",
language = "English",
volume = "34",
pages = "196--204",
journal = "Alimentary Pharmacology and Therapeutics, Supplement",
issn = "0953-0673",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Predicting survival in patients with hepatocellular carcinoma treated by transarterial chemoembolisation

AU - Craxi, Antonio

AU - Di Marco, Vito

AU - Camma', Calogero

AU - Brancatelli, Giuseppe

AU - Cabibbo, Giuseppe

AU - Genco, Chiara

AU - Enea, Marco

AU - Cammà, null

PY - 2011

Y1 - 2011

N2 - 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 timedependent Cox model has the potential to estimate a more precise prognosis in HCC patients treated with TACE.

AB - 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 timedependent Cox model has the potential to estimate a more precise prognosis in HCC patients treated with TACE.

KW - TACE, HCC

UR - http://hdl.handle.net/10447/60815

M3 - Article

VL - 34

SP - 196

EP - 204

JO - Alimentary Pharmacology and Therapeutics, Supplement

JF - Alimentary Pharmacology and Therapeutics, Supplement

SN - 0953-0673

ER -