Efficacy of Chemotherapy versus Transcatheter Arterial Chemoembolization in Patients with Advanced Primary Hepatic Neuroendocrine Carcinoma and an Analysis of the Prognostic Factors: A Retrospective Study

Figures & data

Table 1 Baseline Patients’ Characteristics

	EP/EC	TACE	χ^2 value	P-value
	n=23	n=18
Gender			0.327	0.567
Male	12	11
Female	11	7
Age, years			1.096	0.295
<60	9	10
≥60	14	8
ECOG PS			0.118	0.732
0–1	17	15
2	6	3
AST (U/L)			0.770	0.380
<80	15	14
≥80	8	4
ALT (U/L)			0.006	0.936
<80	18	13
≥80	5	5
HBV			0.004	0.951
Negative	13	10
Positive	10	8
Ki-67			0.891	0.345
<60%	8	3
≥60%	15	15
CgA			2.625	0.105
Positive	16	8
Negative	7	10
Syn			0.049	0.825
Positive	22	16
Negative	1	2
Tumor number			0.000	1.000
Single	3	3
Multiple	20	15
Metastasis			0.646	0.422
Yes	17	16
No	6	2

Abbreviations: EP, etoposide combined with cisplatin; EC, etoposide combined with carboplatin; TACE, transcatheter arterial chemoembolization; ECOG PS, Eastern Cooperative Oncology Group performance status; AST, aspartate aminotransferase; ALT, alanine aminotransferase; HBV, hepatitis B virus; CgA, chromogranin A; Syn, synaptophysin.

Table 2 Univariate and Multivariate Analyses of Clinicopathologic Factors and Treatment Options for Progression-Free Survival of Patients with Primary Hepatic Neuroendocrine Carcinoma

Characteristics	Univariate Analysis			Multivariate Analysis
	HR	95% CI	P-value	HR	95% CI	P-value
Gender
Male	1
Female	0.706	0.373–1.337	0.286
Age
<60	1
≥60	1.309	0.699–2.452	0.400
ECOG PS
0–1	1			1
2	7.699	2.836–20.899	<0.001	9.823	3.453–27.946	<0.001
AST (U/L)
<80	1
≥80	0.611	0.305–1.223	0.164
ALT (U/L)
<80	1
≥80	0.780	0.378–1.609	0.501
HBV
Negative	1
Positive	1.332	0.697–2.545	0.386
Ki-67
<60%	1
≥60%	0.636	0.307–1.316	0.223
Tumor number
Single	1
Multiple	0.833	0.344–2.016	0.685
Metastasis
No	1
Yes	1.938	0.847–4.434	0.117
Treatment
EP/EC	1			1
TACE	2.593	1.294–5.196	0.007	3.046	1.520–6.105	0.002

Note: The bold font means the P-value was significant.

Abbreviations: HR, hazard ratio; CI, confidential interval; ECOG PS, Eastern Cooperative Oncology Group performance status; AST, aspartate aminotransferase; ALT, alanine aminotransferase; HBV, hepatitis B virus; EP, etoposide combined with cisplatin; EC, etoposide combined with carboplatin; TACE, transcatheter arterial chemoembolization.

Table 3 Univariate and Multivariate Analyses of Clinicopathologic Factors and Treatment Options for Overall Survival of Patients with Primary Hepatic Neuroendocrine Carcinoma

Characteristics	Univariate Analysis			Multivariate Analysis
	HR	95% CI	P-value	HR	95% CI	P-value
Gender
Male	1
Female	0.809	0.425–1.539	0.519
Age
<60	1
≥60	1.021	0.984–1.060	0.264
ECOG PS
0–1	1			1
2	3.197	1.462–6.992	0.004	6.104	2.419–15.400	<0.001
AST (U/L)
<80	1
≥80	1.406	0.705–2.805	0.333
ALT (U/L)
<80	1
≥80	1.357	0.654–2.815	0.412
HBV
Negative	1
Positive	0.640	0.333–1.230	0.181
Ki-67
<60%	1			1
≥60%	3.358	1.465–7.697	0.004	3.890	1.581–9.573	0.003
Tumor number
Single	1			1
Multiple	3.107	1.062–9.087	0.038	2.188	0.751–6.376	0.151
Metastasis
No	1
Yes	1.960	0.853–4.499	0.113
Treatment
EP/EC	1			1
TACE	1.943	1.017–3.713	0.044	2.262	1.128–4.538	0.022

Note: The bold font means the P-value was significant.

Abbreviations: HR, hazard ratio; CI, confidential interval; OS, overall survival; ECOG PS, Eastern Cooperative Oncology Group performance status; AST, aspartate aminotransferase; ALT, alanine aminotransferase; HBV, hepatitis B virus; EP, etoposide combined with cisplatin; EC, etoposide combined with carboplatin; TACE, transcatheter arterial chemoembolization.

Figure 1 Progression-free survival and overall survival of patients according to treatment options (A and B) and ECOG PS (C and D); overall survival of patients according to tumor number (E) and Ki-67 index (F).

Abbreviations: EP, etoposide combined with cisplatin; EC, etoposide combined with carboplatin; TACE, transcatheter arterial chemoembolization; ECOG PS, Eastern Cooperative Oncology Group performance status.

Table 4 Treatment-Related Adverse Events

Adverse Events	EP/EC (n=23)		TACE (n=18)
	All Grades	Grade 3/4	All Grades	Grade 3/4
Hematological
Leukopenia	17 (73.9%)	4 (17.4%)	7 (38.9%)	2 (11.1%)
Neutropenia	7 (30.4%)	3 (13.0%)	2 (11.1%)	1 (5.6%)
Anemia	15 (65.2%)	3 (13.0%)	5 (27.7%)	2 (11.1%)
Febrile neutropenia	7 (30.4%)	1 (4.3%)	1 (5.6%)	1 (5.6%)
Thrombocytopenia	12 (52.2%)	3 (13.0%)	4 (22.2%)	1 (5.6%)
Non-hematological
Bilirubin	9 (39.1%)	0	2 (11.1%)	0
AST	6 (26.1%)	2 (8.7%)	3 (16.7%)	0
ALT	7 (30.4%)	2 (8.7%)	3 (16.7%)	1 (5.6%)
Fatigue	7 (30.4%)	1 (4.3%)	4 (22.2%)	1 (5.6%)
Nausea	14 (60.9%)	6 (26.1%)	8 (44.4%)	3 (16.7%)
Vomiting	12 (52.2%)	5 (21.7%)	8 (44.4%)	3 (16.7%)
Anorexia	9 (39.1%)	3 (13.0%)	3 (16.7%)	0
Diarrhea	3 (13.0%)	0	0	0
Post-embolization syndrome	0	0	8 (44.4%)	3 (16.7%)
Bleeding	0	0	4 (22.2%)	1 (5.6%)

Abbreviations: EP, etoposide combined with cisplatin; EC, etoposide combined with carboplatin; TACE, transcatheter arterial chemoembolization; AST, aspartate aminotransferase; ALT, alanine aminotransferase.