Submit Manuscript | http://medcraveonline.com Abbreviations: TACE, transarterial chemo embolization; HCC, hepatocellular carcinoma Lay summary: Early de compensated cirrhotic patients with liver cancer have more option of treatment by TACE. Introduction Liver cancer is the sixth most common cancer worldwide and the second most common cause of cancer-related death. More than 90% of liver cancers are hepatocellular carcinoma (HCC). 1 Staging is currently based on the Barcelona Clinic Liver Cancer (BCLC) staging system which includes tumor burden, liver function, and patient performance status. Treatments are stratifed according to the BCLC stages. 1,2 Tran arterial chemo embolization (TACE) is a modality of choice for HCC patients with BCLC stage B (intermediate stage). TACE can also be applied in very early and early stage HCC when surgery or loco- regional therapies are not eligible due to tumor location or medical comorbidities. 3 TACE was initially proved to improve survival in HCC by several studies; however, most of the patients in these studies were in Child A. 4‒7 According to the guidelines, TACE is recommended for Child A and highly selected Child B by the American Association for the Study of Liver Disease, 1 for Child A by the European Association for the Study of the Liver, 2 and Asian Pacifc Association for the Study of the Liver. 3 Thailand guideline 2015 states that patients with Child ≥9 are an absolute contraindication for TACE. In Thailand, most HCC patients often come with late presentation; therefore, they tend to be in the intermediate to advanced stage and have impaired liver function. 8‒12 From the experience in our institution, TACE is sometimes applied to patients beyond the criteria due to ineligibility of other loco-regional therapies and limited access to sorafenib or liver transplantation. Some Child-Pugh B patients with scores of 8 or 9 undergo TACE with questionable outcomes. Few studies, so far, have clarifed the effect of high Child scores on the outcome of TACE and the results are conficting. Therefore, we aimed to study the outcomes of TACE in HCC patients in terms of overall survival among different Child scores and to determine the predictors for survival at a tertiary care hospital. Materials and methods A retrospective cohort study was conducted at Songklanagarind Hospital, Prince of Songkla University, Thailand. We recruited patients diagnosed with HCC (ICD10 code C22.0) from January 1, 2007 to December 31, 2016 from the hospital database. The inclusion criteria were patients aged ≥18, frst diagnosed with HCC, underwent TACE as monotherapy or combination therapy, and had at least 1 OPD Gastroenterol Hepatol Open Access. 2018;9(6):249‒253. 249 © 2018 Cheewasereechon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Outcome and predictors of transarterial chemo embolization in decompensate cirrhotic hepatocellular carcinoma patients Volume 9 Issue 6 - 2018 Natcha Cheewasereechon, Sawangpong Jandee, Teerha Piratvisuth Department of Internal Medicine, Prince of Songkla University, Thailand Correspondence: Natcha Cheewasereechon, NKC Institute of Gastroenterology and Hepatology, Department of Internal Medicine, Prince of Songkla University, Karnjanavanit Rd, Hat Yai, Songkhla, Thailand 90110 Tel +6674451965, Email Received: June 01, 2018 | Published: November 20, 2018 Abstract Background: Transarterial chemo embolization (TACE) is recommended for hepatocellular carcinoma (HCC) patients with well-preserved liver function. In Thailand, TACE is occasionally performed in decompensated cirrhosis due to limited resources. We compared overall survival by TACE in HCC patients with decompensated cirrhosis to those with compensated cirrhosis. Methods: A retrospective cohort study was conducted at a tertiary hospital. HCC patients were recruited from January 1, 2007 to December 31, 2016 and divided into 3 groups by Child-Pugh scores A, B (7), and B (≥8). Overall survival was the primary outcome. P<.05 was considered statistically significant. Results: A total of 331 hepatocellular patients were included: Child A (66%), Child B (7) (20%), and Child B (≥8) (14%). The mean (SD) follow-up time was 20(16) months and the median survival times were 22, 13, and 12months in Child A, Child B (7), and B (≥8), respectively (P<.001). In comparison between Child B (7) and Child B (≥8), the overall survival rates did not reach statistical difference (P=.91). The overall survival rate in a subgroup of patients with Child B (9) was the worst. Predictors for survival were high serum albumin, tumor size<5cm, TACE frequency >2, multimodality treatment, and absence of complications. Conclusions: TACE can be performed in HCC patients with early de compensated cirrhosis (Child-Pugh score 7–8) resulting in a 1-year survival close to that of Child A. Regarding conflicting Child-Pugh score recommendation for TACE, our study suggests that TACE can be performed in patients with Child score of up to B8. Keywords: carcinoma, hepatocellular, liver neoplasm, chemo embolization, therapeutic, liver cirrhosis, survival analysis Gastroenterology & Hepatology: Open Access Review Article Open Access