Transarterial chemoembolization remains an effective therapy for intermediate‐stage hepatocellular carcinoma with preserved liver function

AIM To evaluate outcomes as well as prognostic factors of transarterial chemoembolization (TACE) in intermediate-stage hepatocellular carcinoma (HCC) with preserved liver function to determine positioning of TACE. METHODS Of the 158 treatment-naive patients with intermediate stage HCC who received initial TACE from February 2007 to January 2016, 113 patients met the following inclusion criteria; no combined therapy within 4 weeks after initial TACE and Child-Pugh score under 7. Response rate and overall survival were evaluated. The prognostic factors were investigated in univariate and multivariate analysis using Cox proportional hazard models. The deterioration of the liver function after repeated TACE were also evaluated. RESULTS The response rate was 92.7% (CR 63.3%, PR 29.4%). The median survival time (MST) was 45.2 months. Survival rate at 1, 2 and 3 years was 90.4%, 77.0% and 60.8% respectively. Age ≥ 75 years (P = .022), serum alpha-fetoprotein (AFP) level ≥ 200 ng/mL (P = .010), tumor number ≥ 11 (P = .008), heterogenous enhancement on dynamic CT (P = .024) were poor prognostic factors. The liver function deterioration occurred 18.5% in Child-Pugh score and 12.3% in ALBI grade after the first TACE, 15.6 and 5.1 %, respectively, after the second TACE, and 14.5 and 11.1 %, respectively, after the third TACE. CONCLUSION Superselective TACE can achieve high tumor response rate with prolonged overall survival for patients with intermediate-stage HCC with preserved liver function. Age and serum AFP level, tumor number ≥ 11 and heterogenous enhancement on dynamic CT demonstrated significantly poor prognosis.