Tace as a Treatment for Hepatocellular Carcinoma in Northern Ireland, What Are The Outcomes?
P Agnew, L Stratton, P Kennedy, W J Cash, N I McDougall
Hepatology Unit, Royal Victoria Hospital, Belfast, Northern Ireland, Radiology Department, Royal Victoria Hospital, Belfast, Northern Ireland
Transarterial chemoembolization (TACE) is used as a palliative treatment in hepatocellular carcinoma (HCC). It can also be used to slow tumour growth in patients that have been accepted for liver transplant. TACE can be carried out alone or with radio frequency ablation (RFA), where appropriate. All TACE in Northern Ireland (NI) are carried out in the regional tertiary referral centre, the Royal Victoria Hospital, Belfast.
To establish the outcomes for patients treated with TACE in NI from January 2006 up to and including January 2014.
Patients who underwent their first TACE treatment for HCC in NI between January 2006 and January 2014 were identified from interventional radiology records. Electronic Care Records were then used in order to obtain patient data. Patients were followed up until July 2015. The study population was divided into subgroups and survival rates calculated up to 5 years in order to compare survival of differing ages, aetiology of liver disease and whether RFA was added to treatment.
131 patients with HCC were included. 105(80%) were male with a mean age of 68. The most common aetiology was alcoholic liver disease at 39(30%). Overall survival was calculated at 64%(125/131) year 1, 43%(84/131) year 2, 34%(40/117) year 3, 33%(36/106) year 4 and 33%(34/101) year 5, including 8 patients who had liver transplant. Survival rates for females were greater than males with 84% (22/26) vs 63%(67/105) year 1, 70%(17/24) vs 45%(45/100) year 2 and 68%(15/22) vs 36%(34/94) year 3. Two year survival decreased from 63% for patients in their 50’s to 38% in their 70’s. 26%(35/131) underwent TACE and RFA. Survival rates for those with TACE and RFA were 97%(34/35) at year 1, 68%(22/32) year 2, 60%(17/28) year 3, 64%(16/25) year 4, 58%(14/24) year 5. The number of TACE for HCC in NI from 2006 until 2013 each year was 6, 11, 15, 14, 14, 18, 29 and 23.
Overall survival in the population study was found to be comparative to previous studies. Females were shown to have a greater survival when compared to male with 2 year survival of 70% vs 45%. It was also found that age had a significant effect on survival rates following TACE with the largest fall in survival rates seen between those under 60 and those over 70. TACE with RFA had significantly favourable outcomes with regard to survival. The use of TACE has increased greatly over the period of the study.