Improved Time to Progression for Transarterial Chemoembolization Compared With Transarterial Embolization for Patients With Unresectable Hepatocellular Carcinoma

In a retrospective nonrandomized comparison of patients with unresectable hepatocellular carcinoma (HCC), transarterial chemoembolization (TACE) increases time to progression and progression-free survival (PFS) when compared with transarterial embolization (TAE). Overall survival was not increased by TACE. Background: Embolizing branches of the hepatic artery lengthens survival for patients with unresectable hepatocellular carcinoma (HCC), but the benefit of combining chemotherapy with the embolizing particles remains controversial. Methods: A retrospective review was undertaken of sequential patients with advanced HCC undergoing embolization in the past 10 years at 2 neighboring institutions and with 2 years of follow-up data. TACE was generally performed with doxorubicin plus mitomycin C. Results: One hundred twenty-four patients were included; 77 received TACE and 47 received TAE. On multivariable analysis stratified by institution, type of embolization and CLIP score significantly predicted PFS and time to progression (TTP), whereas CLIP score and AFP independently predicted overall survival (OS). TACE significantly prolonged PFS and TTP (P = .0004 and P = .001, respectively), but not OS (P = .83). Conclusions: The addition of chemotherapy to TAE prolongs PFS and TTP. Future efforts should focus on adjunctive therapies after the embolization to increase survival.