TY - JOUR
T1 - Transarterial bland versus chemoembolization for hepatocellular carcinoma
T2 - rethinking a gold standard
AU - Massarweh, Nader N.
AU - Davila, Jessica A.
AU - El-Serag, Hashem B.
AU - Duan, Zhigang
AU - Temple, Sarah
AU - May, Sarah
AU - Sada, Yvonne H.
AU - Anaya, Daniel A.
N1 - Funding Information:
This material is based on the work supported in part by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). Funding support had no role in the preparation, review, or approval of the article. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs and Baylor College of Medicine. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Funding Information:
This material is based on the work supported in part by the Department of Veterans Affairs , Veterans Health Administration , Office of Research and Development , and the Center for Innovations in Quality, Effectiveness and Safety ( CIN 13-413 ). Funding support had no role in the preparation, review, or approval of the article. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs and Baylor College of Medicine. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Publisher Copyright:
© 2016
PY - 2016/2
Y1 - 2016/2
N2 - Background: Transarterial chemoembolization (TACE) is the most common procedure for the treatment of hepatocellular carcinoma (HCC). However, HCC is generally considered chemoresistant and data demonstrating the superiority of TACE over bland embolization (TAE) are lacking. Materials and methods: A nationwide, retrospective cohort study of HCC patients treated with first-line TACE or TAE within the Veterans Affairs health care system (2005–2012) was performed. The primary outcome was overall survival. Risk of death by treatment type (TACE or TAE) was evaluated using multivariate (adjusted for age, presence of cirrhosis, Barcelona Clinic Liver Cancer stage, and Charlson comorbidity score) and propensity score-adjusted Cox regression. Results: The cohort included 405 patients treated with first-line transarterial embolization. Among these patients, 32 (7.9%) underwent TAE. Most of the patients (76.8%) had intermediate or advanced stage at presentation. Similar proportions of patients (TACE 53.3% versus TAE 43.7%; P = 0.30) received more than one embolization procedure. There was no difference in median survival (20.1 versus 23.1 mo, respectively; log-rank P = 0.84). Compared to TACE, there was no difference in risk of death associated with TAE after multivariate (hazard ratio [HR] 0.92; 95% CI, 0.61–1.37) and propensity score adjustment (HR = 0.86; 95% CI = 0.58–1.29). Conclusions: There is no clear benefit associated with chemotherapy infusion over bland embolization for HCC treatment. Given the rising incidence of HCC in the United States and considering the added costs associated with TACE compared to TAE, future work comparing these competing management strategies is needed.
AB - Background: Transarterial chemoembolization (TACE) is the most common procedure for the treatment of hepatocellular carcinoma (HCC). However, HCC is generally considered chemoresistant and data demonstrating the superiority of TACE over bland embolization (TAE) are lacking. Materials and methods: A nationwide, retrospective cohort study of HCC patients treated with first-line TACE or TAE within the Veterans Affairs health care system (2005–2012) was performed. The primary outcome was overall survival. Risk of death by treatment type (TACE or TAE) was evaluated using multivariate (adjusted for age, presence of cirrhosis, Barcelona Clinic Liver Cancer stage, and Charlson comorbidity score) and propensity score-adjusted Cox regression. Results: The cohort included 405 patients treated with first-line transarterial embolization. Among these patients, 32 (7.9%) underwent TAE. Most of the patients (76.8%) had intermediate or advanced stage at presentation. Similar proportions of patients (TACE 53.3% versus TAE 43.7%; P = 0.30) received more than one embolization procedure. There was no difference in median survival (20.1 versus 23.1 mo, respectively; log-rank P = 0.84). Compared to TACE, there was no difference in risk of death associated with TAE after multivariate (hazard ratio [HR] 0.92; 95% CI, 0.61–1.37) and propensity score adjustment (HR = 0.86; 95% CI = 0.58–1.29). Conclusions: There is no clear benefit associated with chemotherapy infusion over bland embolization for HCC treatment. Given the rising incidence of HCC in the United States and considering the added costs associated with TACE compared to TAE, future work comparing these competing management strategies is needed.
KW - Hepatocellular carcinoma
KW - Transarterial chemoembolization
KW - Transarterial embolization
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U2 - 10.1016/j.jss.2015.09.034
DO - 10.1016/j.jss.2015.09.034
M3 - Article
C2 - 26507276
AN - SCOPUS:84973407718
SN - 0022-4804
VL - 200
SP - 552
EP - 559
JO - Journal of Surgical Research
JF - Journal of Surgical Research
IS - 2
ER -