Relation between transcatheter arterial chemoembolization and time of death in patients with hepatic carcinoma

Objective: To evaluate the relationship between transcatheter arterial chemoembolization (TACE) and time of death in hepatic carcinoma patients.

Methods: One hundred and ninety-five patients (male 188, female 7) with liver cancer underwent TACE with patients dying at different intervals after treatment. Dose of antitumor drugs, amount of iodized oil, liver function, size, recurrence of surgical resection, pattern of tumor, metastasis, presence of portal vein thrombosis, post TACE relapse, post TACE liver function and AFP, etc, altogether 15 variables were subjected to statistical analysis with the Cox's hazard proportional model.

Results: According to univariate and forward stepwise regression analysis, factors associated with significantly worse survival were diffused type, multi-nodular growth of tumor, and tumor embolus in the portal vein (P < 0.0001). Before death, most patients had symptoms of chest oppression, shortness of breath, ascites, abdominal distension, jaundice, hepatic failure and hematemesis. Causes of death were hepatic coma (27.2%, n = 53), hepatic failure (23.1%, n = 45), hemorrhage from the digestive tract (36.9%, n = 72), multiple organ failure (5.1%, n = 10) and others (7.2%, n = 14).

Conclusions: Several factors of TACE may lead to failure in liver function and death. TACE may hasten death in patients with severe liver functional embarrassment. Before instituting TACE, careful weighing the pros and cons of the general condition and liver function is important for patients with portal vein embolism, multiple tumors or diffused lesions. Tolerance of liver to the drug, time, dose and method of treatment should be meticulously and carefully planned. Post TACE protection of liver is also very important.