Multivariate Analysis of Prognostic Factors for Survival Following Doxorubicin-eluting Bead Transarterial Chemoembolization for Hepatocellular Carcinoma Open Access

Abstract

Multivariate analysis of prognostic factors for survival following doxorubicin-eluting bead transarterial chemoembolization for hepatocellular carcinoma.

Abstract

Purpose. To identify prognostic factors for survival in hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization with doxorubicin-eluting beads (DEB-TACE).

Methods. This is a retrospective, single-center analysis of patients with HCC treated with DEB-TACE. Tumor- and patient-related factors were recorded for univariate and multivariate analyses via Kaplan-Meier and Cox regression. Infiltrative HCC phenotype and portal vein invasion (PVI) were correlated, and patients having either or both were classified as "radiographically advanced HCC" (RAdv-HCC). The primary endpoint was overall survival, which was calculated from the time of first DEB-TACE.

Results. 135 patients underwent 248 procedures. 215 (86.7%) were outpatient procedures, and mean length of stay was 0.33 days; 25 (10.1%) were readmitted within 30 days. 130 had cirrhosis; 62, 50 and 18 were Child's A, B and C, respectively. 41 had infiltrative HCC phenotype, 28 of whom also had PVI. Multivariate analysis of survival in all patients showed AFP, performance status (PS), RAdv-HCC, Child's classification, albumin and ascites to predict survival. In patients without RAdv-HCC, AFP, PS, Child classification, albumin and INR were independent predictors. Elevated bilirubin was not an independent risk factor for death.

Conclusion. Independent prognostic factors in HCC patients undergoing DEB-TACE are identified. Elevated bilirubin was not an independent risk factor. These data can be used in HCC patient selection and counseling for DEB-TACE.

Table of Contents

TABLE OF CONTENTS

Introduction………………………………………………………………………………………5

Materials and Methods

Patients and variables………………………………………………………………….5

Treatment………………………………………………………………………………..8

Statistical analyses……………………………………………………………………..9

Results………………………………………………………………………………………….10

Survival analyses

Overall…………………………………………………………………………..11

Without Radiographically Advanced Hepatocellular Carcinoma………….12

Discussion………………………………………………………………………………………14

References……………………………………………………………………………………..19

Tables

Table 1………………………………………………………………………………….22

Table 2………………………………………………………………………………….24

Table 3……………………………………………………………………………….…26

Table 4………………………………………………………………………………….27

Figures

Figure 1…………………………………………………………………………………28

Figure 2…………………………………………………………………………………29

Figure 3…………………………………………………………………………………30

Figure 4…………………………………………………………………………………31

Figure 5…………………………………………………………………………………32

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery Health Sciences, Oncology Health Sciences, Radiology
Keyword	Chemoembolization Prognostic factors for survival Hepatocellular carcinoma
Committee Chair / Thesis Advisor	Yang, Zhou, Emory University
Committee Members	Johnson, Mark, Piedmont Hospital
Partnering Agencies	Does not apply (no collaborating organization)

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