1. Transarterial chemoembolization
in patients with hepatocellular
carcinoma:
Who are the best candidates?
Mohamed Bouattour1, Nathalie Goutte2, Marie Pierre Vuillierme4,
Mohamed Abderrahim4, Valérie Vilgrain4, Sandrine Faivre 3,
Eric Raymond 3, Laurent Castera 2,Olivier Farges5
1. Oncology/Hepatology 2.Hepatology 3.Oncology 4.Radiology 5.Surgery
Beaujon University Hospital
Clichy, France

2. BACKGROUND & AIM
• Transarterial chemoembolization (TACE) is the most
commonly used palliative treatment in patients with
hepatocellular carcinoma (HCC)
• However, identification of the best candidates who will
benefit the most from TACE is still a matter of debate
• The aim of this study was to analyze survival after TACE
as well as prognostic factors in order to determine the
optimal candidates for TACE

3. METHODS
• All patients treated with conventional lipiodol TACE alone
as first line treatment in our institution from January 2006
to October 2009 were retrospectively selected from a
prospective database
• For each patient, TACE was indicated after discussing all
treatment options during our multidisciplinary HCC
meeting
• TACE was as selective as possible according to tumor
size and tumor feeders
• Clinical, biological, radiological data and tumor features
were collected for all patients
• Survival was estimated using the method of Kaplan Meyer
and prognostic factors using Cox-model-based analysis

4. RESULTS
• During the period of the study, 485 patients with HCC were treated in
our institution. Among them, we selected for this study the 122
patients treated with TACE alone as first line treatment.
• Patients characteristics were summarized in table 1
• Follow-up
– After a median follow-up of 30.1 months, 52 (42.6 %) patients
have died
– The median overall survival after the first TACE was 30 months
for the entire cohort (Figure 1)
– The cumulative 12, 24 and 36 months survival rates were: 76.7%,
55.6% and 45%, respectively
• Complications
No treatment-related death was observed and only 2
patients (1.6%) experienced serious complications (liver
abscess and cholecystitis each)

5. Table 1. Patients characteristics and tumor
features
Median age (Years) 64.7
Male – n (%) 122 (79)
Etiology of underlying liver disease n (%)
Viral C / Viral B 51 (41)/ 16 (13)
Alcohol 33 (26)
Other 25 (20)
Child-Pugh score – n (%)
Class A / Class B 98 (80) / 24 (20)
Albumin – n (%)
> 35 g/l/ < 35 g/l 98 (80)/24 (20)
Bilirubin – n (%)
< 35 µmol/l / > 35 µmol/l 111 (91) / 11 (9)
Transaminase - n (%)
<2N/>2N 67 (55) / 55 (45)
Tumor stage BCLC- n (%)
A/B/C 50 (41) / 63 (52) / 7 (9)
Vascular invasion – n (%)
Yes / No 11 (9) / 111(91)
Number of lesions – n (%)
≤3/>3 56 (46) / 66 (56)
Tumor diameter (cm) 3.6 ± 2.1
AFP – n (%)
≥ 20 UI/ml / < 20 UI/ml 63 (52) / 59 (48)

6. Figure 1. Kaplan–Meier estimated survival curve for the cohort
After first TACE, median overall survival was 30 months

7. Univariate analysis
• In univariate analysis, variables significantly associated
with better survival were:
 Child-Pugh class A (p < 0.0003)
 viral etiology of cirrhosis (p < 0.01)
 transaminase ≤ 2 NL (p < 0.005)
 albumin ≥ 35 g/l (p < 0.01)
 AFP < 20 UI/ml (p < 0.05)
 bilirubin < 35 μmol/l (p < 0.001) and
 absence of vascular invasion (p < 0.03)

8. Multivariate analysis of the factors of survival
• In multivariate analysis, better survival was independently
associated with Child-Pugh class A, AFP < 20 UI/ml and
absence of vascular invasion (table 2)
Variables Hazard ratio (95% CI) P
Child-Pugh class A 3.6 (1.72-7.40) p < 0.0004
4.7 (1.06 – 5.80)
AFP < 20 UI/ml p < 0.009
Absence of vascular
3.7 (1.06 - 13.09) p < 0.03
inavasion

9. Best candidate to TACE in our serie
• Patients with Child Pugh class A, normal AFP plasma level, without
vascular invasion treated with TACE had better survival than patients
without these criteria: > 40 months (30.1 – NA , 95% CI) vs. 28 months,
(20.4 - 42.7, 95% CI; p = 0.03) (Figure 2)

10. CONCLUSION
• TACE is a safe and well tolerated treatment
• Careful selection of patients is mandatory to achieve
survival benefit
• Patients with compens ate liver function, normal AFP,
without vascular invasion are the best candidates for
TACE