Department of Internal Medicine, Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul 04401, Korea.
Department of Radiology, Soonchunhyang University College of Medicine, Seoul 04401, Korea.
Int J Mol Sci. 2020 Oct 31;21(21):8165. doi: 10.3390/ijms21218165.
Transarterial chemoembolization (TACE) is a standard treatment for intermediate-stage hepatocellular carcinoma (HCC). In this review, we summarize recent updates on the use of TACE for HCC. TACE can be performed using two techniques; conventional TACE (cTACE) and drug-eluting beads using TACE (DEB-TACE). The anti-tumor effect of the two has been reported to be similar; however, DEB-TACE carries a higher risk of hepatic artery and biliary injuries and a relatively lower risk of post-procedural pain than cTACE. TACE can be used for early stage HCC if other curative treatments are not feasible or as a neoadjuvant treatment before liver transplantation. TACE can also be considered for selected patients with limited portal vein thrombosis and preserved liver function. When deciding to repeat TACE, the ART (Assessment for Retreatment with TACE) score and ABCR (AFP, BCLC, Child-Pugh, and Response) score can guide the decision process, and TACE refractoriness needs to be considered. Studies on the combination therapy of TACE with other treatment modalities, such as local ablation, radiation therapy, or systemic therapy, have been actively conducted and are still ongoing. Recently, new prognostic models, including analysis of the neutrophil-lymphocyte ratio, radiomics, and deep learning, have been developed to help predict survival after TACE.
经动脉化疗栓塞术(TACE)是治疗中期肝细胞癌(HCC)的标准治疗方法。在这篇综述中,我们总结了 TACE 治疗 HCC 的最新进展。TACE 可以使用两种技术进行:传统 TACE(cTACE)和载药微球 TACE(DEB-TACE)。这两种方法的抗肿瘤效果相似,但 DEB-TACE 发生肝动脉和胆管损伤的风险较高,术后疼痛的风险相对较低。如果其他治愈性治疗方法不可行,或作为肝移植前的新辅助治疗,TACE 可用于早期 HCC。TACE 也可考虑用于有限门静脉血栓形成和保留肝功能的选定患者。决定重复 TACE 时,可以使用 ART(TACE 再治疗评估)评分和 ABCR(AFP、BCLC、Child-Pugh 和反应)评分来指导决策过程,并需要考虑 TACE 抵抗。TACE 与局部消融、放射治疗或系统治疗等其他治疗方式联合治疗的研究正在积极进行中。最近,已经开发了新的预后模型,包括中性粒细胞-淋巴细胞比值分析、放射组学和深度学习,以帮助预测 TACE 后的生存情况。
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