Prognostic Factors for Survival in Patients with Hepatocellular Carcinoma Treated By Transarterial Chemoembolization Using Drug-Eluting Beads

Objective: Transarterial chemoembolization (TACE) is the most widely used therapeutic option in the treatment of intermediate hepatocellular carcinoma (HCC). Due to the heterogeneity of the intermediate stage patient population, survival rates are variable. The purpose of this retrospective study was to investigate prognostic factors in predicting overall survival in patients with HCC treated by transarterial chemoembolization using drug-eluting beads loaded with doxorubicin (DEBDOX TACE). Methods: 119 patients with intermediate stage HCC who had undergone DEBDOX TACE between February 2010 and January 2017 were studied. All procedures were performed under Cone Beam Computed Tomography (CBCT) control. Survival was calculated from the date of the first procedure. The survival rates and curves were calculated using the Kaplan-Meier method. Survival curves were compared using the log-rank test.Results: Overall, 362 procedures were performed (mean: 3.04 per patient). After a mean follow up of 24.5 ± 1.3 months, 83  patients had died and 36 survived. The average survival was 30.7 months ± 2.3 months (95% CI: 26.3-35.2 months). Median survival was 24.7 months. One-year, two-year and five-year survival rates were 84%, 47% and 3%, respectively. Independent survival prognostic factors were Child-Pugh class ,B (p=0.009), ascites (p=0.019), portal hypertension (p=0.024), bilirubin increase after procedure (p=0.002) and number of procedures (p=0.022).Conclusion: The presence of ascites, portal hypertension,  Child-Pugh class B, Child-Pugh score, a higher increase in bilirubin levels after the procedure and a lower number of DEBDOX TACE procedures are significant prognostic factors in  overall survival.