Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China.
Department of Hepatic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.
Eur Radiol. 2021 Nov;31(11):8291-8301. doi: 10.1007/s00330-021-07834-9. Epub 2021 Apr 24.
This study aims to compare the safety and effectiveness between transarterial chemoembolization (TACE) with drug-eluting beads (DEB-TACE) and conventional TACE (cTACE) using lipiodol-based regimens in HCC patients with a transjugular intrahepatic portosystemic shunt (TIPS).
This retrospective study included patients with patent TIPS who underwent TACE from January 2013 to January 2019 that received either DEB-TACE (DEB-TACE group, n = 57) or cTACE (cTACE group, n = 62). The complications, liver toxicity, overall survival (OS), time to progression (TTP), and objective response rate (ORR) were compared between the groups.
Altogether, 119 patients (50 ± 11 years, 107 men) were evaluated. The incidence of adverse events, including abdominal pain within 7 days (45.6% vs 79.0%, p < 0.001) and hepatic failure within 30 days (5.3% vs 19.4%, p = 0.027), were significantly lower in the DEB-TACE group than in the cTACE group. Compared to the cTACE group, the DEB-TACE group also showed mild liver toxicities in terms of increased total bilirubin (8.8% vs 22.6%), alanine aminotransferase (5.3% vs 21.0%), and aspartate aminotransferase (10.5% vs 29.0%) levels. The DEB-TACE group had better ORR than the cTACE group (70.2% vs 50.0%). The median OS and TTP were longer in the DEB-TACE group (11.4 vs 9.1 months, hazard ratio [HR] = 2.46, p < 0.001; 6.9 vs 5.2 months, HR = 1.47, p = 0.045). Multivariable analysis showed that α-fetoprotein levels, Barcelona clinic liver cancer stage, and treatment allocation were independent predictors of OS.
DEB-TACE is safe and effective in HCC patients with a TIPS and is potentially superior to cTACE in terms of complications, liver toxicities, OS, TTP, and ORR.
• DEB-TACE is safe and effective in HCC patients after a TIPS procedure. • DEB-TACE improves overall survival, objective response rate, and liver toxicities and is non-inferior to cTACE in terms of time to progression. • DEB-TACE might be a potential new therapeutic option for HCC patients with TIPS.
本研究旨在比较经颈静脉肝内门体分流术（TIPS）存在时，使用载药微球的经动脉化疗栓塞术（DEB-TACE）与传统 TACE（cTACE）在 HCC 患者中的安全性和有效性。
本回顾性研究纳入了 2013 年 1 月至 2019 年 1 月期间 TIPS 通畅且接受 TACE 治疗的患者，分为 DEB-TACE 组（n=57）和 cTACE 组（n=62）。比较两组患者的并发症、肝毒性、总生存期（OS）、无进展生存期（TTP）和客观缓解率（ORR）。
共纳入 119 例患者（50±11 岁，107 例男性）。DEB-TACE 组不良事件发生率，包括 7 天内腹痛（45.6% vs. 79.0%，p＜0.001）和 30 天内肝衰竭（5.3% vs. 19.4%，p=0.027）均显著低于 cTACE 组。与 cTACE 组相比，DEB-TACE 组在胆红素（8.8% vs. 22.6%）、丙氨酸氨基转移酶（5.3% vs. 21.0%）和天冬氨酸氨基转移酶（10.5% vs. 29.0%）水平方面也表现出较轻的肝毒性。DEB-TACE 组的 ORR 高于 cTACE 组（70.2% vs. 50.0%）。DEB-TACE 组的中位 OS 和 TTP 均长于 cTACE 组（11.4 个月 vs. 9.1 个月，HR=2.46，p＜0.001；6.9 个月 vs. 5.2 个月，HR=1.47，p=0.045）。多变量分析显示，甲胎蛋白水平、巴塞罗那临床肝癌分期和治疗分配是 OS 的独立预测因素。
DEB-TACE 用于 TIPS 术后 HCC 患者是安全有效的，在并发症、肝毒性、OS、TTP 和 ORR 方面，其效果可能优于 cTACE。
• DEB-TACE 在 TIPS 术后 HCC 患者中安全有效。• DEB-TACE 可提高总生存率、客观缓解率和肝毒性，并在 TTP 方面与 cTACE 相当。• DEB-TACE 可能是 TIPS 存在时 HCC 患者的一种潜在新的治疗选择。
