Prognostic factors associated with survival in patients with hepatocellular carcinoma undergoing transarterial chemoembolisation: an Australian multicenter cohort study

Aim: Transarterial chemoembolisation (TACE) is recommended therapy for intermediate-stage hepatocellular carcinoma (HCC). However, the wide variations in outcomes reflect significant heterogeneity of this patient group. We evaluated the prognostic factors associated with survival in a real-world setting to identify those at high risk of a poor outcome. Methods: Patients with HCC who underwent initial TACE at six tertiary hospitals between 2009 to 2014 were included via an extensive search of hospital databases and electronic medical records. Overall survival (OS) was measured from the date of initial treatment to the date of death or last follow-up. Univariate and multivariate Cox regression analyses were used to assess the effects of baseline variables on post-TACE survival. Results: The majority of the 431 eligible patients were Caucasian (80%), male (87%), with a mean age of 66 years and had alcohol-related cirrhosis (43%). Most were Child-Pugh A (69%) with BCLC stage A (59%) or B (35%) disease, with a median OS of 28 months. On multivariate analysis, pre-treatment ascites (P = 0.001) and larger HCC (P < 0.001) were associated with worse overall survival, while higher serum albumin (P < 0.001) and HBV (P = 0.005) were associated with improved survival. Conclusion: Patients with advanced liver disease, including the presence of ascites and lower serum albumin, as well as those with greater tumour burden, have poorer outcomes following TACE treatment. Such findings provide a better understanding of the variation in survival after TACE and are helpful in facilitating selection and timely stage migration of patients undergoing this therapy.