| Summary: | 碩士 === 弘光科技大學 === 健康事業管理研究所 === 103 === Background：
Transarterial chemoembolization (TACE) is the standard care for hepatocellular carcinoma (HCC) in BCLC intermediate stage ，and good responses to TACE account for better patient outcomes. For acheiving good responses to TACE , patients may need to receive TACE for several times. The survival impacts of subsequent response to TACE have not been fully evaluated。
Purpose :
We aim to analyze the prognostic factors of HCC patients undergoing TACE, including the best responses to TACE。
Methods :
We retrospectively included 609 HCC patients received TACE as an initial treatment from January 2005 to December 2009, and patients with missing dynamic image data prior to TACE treatment , vascular invasion or extra hepatic metastasis were excluded. Totally, 145 patients with intermediate-stage HCC were recruited for analysis, and patients had been followed up until the end of 2014. Data of potentially prognostic factors, including the best tumor responses to TACE during study period, were collected for survival analyses. Cumulative incidences of patient mortality were calculated and compared by Kaplan-Meier analysis. On multivariate analyses, hazard ratios (HRs) for patient mortality were analyzed using Cox proportional hazard regression model.
Results :
Baseline characteristics of the 145 patient are summarized in Table 1, and patients with intermediate stage HCC who received TACE as initial treatment were generally old and male-predominant. Chronic hepatitis B was the most frequent cause of HCC in cohort, and most patients where in Child-Pugh class A status. The tumor sizes were usually big with a median maximum diameter of tumor was 7.5 cm. After initial and subsequent TACE treatments, complete response (CR) was achieved in 18 patients, and partial response (PR) was achieved in 47 patients. However, only stable disease (SD) can be achieved in 48 patients, and 32 patients suffered from progression disease (PD) even repeating TACE. HCCs with larger tumor sizes were accounted for worse tumor responses to TACE (Table 2). On multivariate analyses, maximum tumor diameter (Hazard ratio [HR]: 1.07; 95% confidence interval [CI]: 1.02–1.13), previous tumor hemorrhage (HR: 1.93; 95% CI: 1.10–3.38), the best responses to TACE treatment during study period (CR [HR: 0.13; 95% CI: 0.05–0.30], PR [HR: 0.29; 95% CI:0.17–0.48], SD (HR: 0.54; 95% CI: 0.33–0.87]，best responder achieve TACE session；initial responders (Hazard ratio [HR]: 1.07; 95% confidence interval [CI]: 1.02–1.13), subsequent respondersprevious (Hazard ratio [HR]: 1.07; 95% confidence interval [CI]: 1.02–1.13) tumor hemorrhage (HR: 1.93; 95% CI: 1.10–3.38)to inwere independent prognostic factors to patient survival .
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