Quimioembolização de carcinoma hepatocelular: como tratamento exclusivo e também ponte para transplante de fígado

Abstract

Hepatocellular carcinoma (HCC) is the most common type of liver cancer. Surgical resection, ablation and liver transplantation (LT) are the curative treatment options in cirrhotic patients with early restricted liver tumor without macrovascular invasion and / or distant metastasis. Chemoembolization (transcatheter arterial chemoembolization-TACE) is the palliative treatment of HCC. This procedure is beneficial in up to 55% of cases because it reduces the rate of tumor progression and vascular invasion, with evidence suggesting increased survival. Objectives: To evaluate the survival of patients undergoing the exclusive TACE procedure, and to identify the causes of death within the first six months; and to analize the efficacy of TACE as a bridge procedure for liver transplantation. Methods: We retrospectively selected all records of 134 HCC patients submitted to 224 TACE, from January 2000 to July 2016. Of these, 69 patients had exclusive treatment for chemoembolization. As a bridge treatment for transplant; 65 patients were analyzed. Statistical analysis was performed using the Kaplan-Meier method and Gehan-Breslow-Wilcoxon test, with a significance level of p <0.05. Results: The survival rate was 28.51% for 1266 days (three years and five months) in the exclusive TACE, the highest survival rate was in Child-Pugh A. Patients who underwent TACE as a bridge for transplantation, the survival rate, in 3000 days (eight years and two months), was 71.55% in patients submitted to liver transplantation, and 18.87% in patients who left the transplant waiting list, with statistical significance (p = 0.0138). Conclusion: TACE is an option that increases the survival rate in patients Child-Pugh A who have no indication of curative treatment. However, patients with alpha-fetoprotein greater than 244.4 ng/ml, Child-Pugh B and C, a higher mortality rate was when they were submitted to chemoembolization. According to the analysis of the TACE procedure as a bridge for liver transplantation, we observed that only 41.54% of the patients had the effectiveness for LT.