Survival and Its Predictors Among Patients Receiving Transarterial Chemoembolization for Hepatocellular Carcinoma in Ethiopia: A 6-Year Follow-Up Study.

Abstract

To analyze survival and its predictors among patients with hepatocellular carcinoma (HCC) receiving transarterial chemoembolization (TACE) in Ethiopia. We conducted a retrospective cohort study among patients who received TACE for HCC at MCM Hospital from December 1, 2016, to December 31, 2022. Data were extracted from patients' medical records, and vital status was ascertained from the patients' charts or by phone call to the next of kin. We used Kaplan-Meier estimator to determine survival functions and log-rank test to compare the survival functions in different groups. Predictors of survival were identified using a multivariable Cox proportional hazards regression model as expressed by adjusted hazard ratio (aHR). Of the total 257 patients included in the study, 68.9% were male, with a mean age of 56.5 (±14.06) years, and 86% were diagnosed at the advanced stage of the cancer (Barcelona Clinic Liver Cancer-C). The median overall survival was 12.7 months (95% CI, 10.57 to 14.85), and the overall survival rate at 1 year, 2 years, 3 years, 4 years, 5 years, and 6 years was found to be 58.0% (95% CI, 51.8% to 63.8%), 24.1% (95% CI, 19.1% to 29.6%), 8.2% (95% CI, 5.1% to 11.7%), 7.0% (95% CI, 3.9% to 10.1%), 1.6% (95% CI, 0.4% to 3.1%), and 1.2% (95% CI, 0.1% to 2.7%), respectively. The probability of death was significantly increased by alpha-fetoprotein level <400 ng/mL (aHR, 5.72 [95% CI, 1.52 to 21.51]), albumin level (aHR, 5.03 [95% CI, 1.41 to 18.01]), and bilobar distribution (aHR, 5.67 [95% CI, 1.40 to 23.04]). The findings of the study underscore the need for the expansion of preventive measures and treatment facilities to address the overwhelming burden of HCC in Ethiopia.