The effect of transarterial chemoembolization on the survival of hepatocellular carcinoma patients

OBJECTIVE: Transarterial chemoembolization is a widely used treatment method forinoperable hepatocellular carcinoma. Many factors effect the outcome of the treatment.The aim of this research is to investigate the effects of the following factors on the patientsurvival tumour morphology, Child?s classification, Okuda staging, liver functional tests,serum alphafetoprotein level, presence of portal vein thrombosis, different embolizingagents, technique of embolization, presence of postembolectomic syndrome andpostembolectomic complications, etiology, lipiodol accumulation types in tumour on CT,tumour response to treatment, gender, additional disease, age and number ofchemoembolization session.MATERIAL AND METHOD: The results of 38 patients with inoperable hepatocellularcarcinoma were analyzed retrospectively. All of the patients underwent transarterialchemoembolization with polivinyl alcohol or gelfoam particles after doxorubicin andlipiodol emulsion were applied. Kaplan-Meier method and Logrank test were used toanalyze the effect of determined parameters on survival. Chi-square test with Yate?scorrection was used to compare the parameters.RESULTS: Survival at 1, 2 and 3 years was 52%, 35% and 19%, respectively. There wasno statistically significant difference between the groups according to Child?sclassification and Okuda staging. The survival at 1, 2 and 3 years for polivinylalcoholgroup (n=20) was 65%, 48% and 24% and for the gelfoam group (n=18) was 40%, %25and 15% respectively. The difference between the survival rates of these two groups wasnot significant statistically (p>0,05). The distribution of complications and tumourresponse to treatment were similar for each group. The effect of tumour response totreatment, age, lipiodol accumulation type, number of tumor focus in liver, complicationsafter the treatment and serum alphafetoprotein level on survival were statisticallysignificant (p<0,05).CONCLUSION: Transarterial chemoembolization was found to improve survival rates ofthe patients included in this study when compared to the survival rates of no treatmentfollow up patients in literature. Tumor response to treatment, lipiodol accumulation type,age, number of tumour focus, serum alphafetoprotein level were found to effectcumulative survival rates. Gender, etiology, tumour size, percentage of infiltrated livertissue, embolizing agent were found to have no effect on survival rates. The results of thisstudy is parallel to similar studies in literature. However the effect of parameters onsurvival rates needs to be investigated by randomized controlled clinical trials on largerpatient groups.Key Words: Hepatocellular carcinoma, polyvinyl alcohol, gelfoam, transarterialchemoembolization.