Razi Murtuza, Safiullah Syed, Gu Jianping, He Xu, Razi Mustafa, Kong Jie
Department of Interventional Radiology, Nanjing Medical University Third School of Clinical Medicine, Nanjing First Hospital, Nanjing, Jiangsu, 210006, China.
Department of Diagnostic and Interventional Radiology, Omega Hospitals, Rd no.12 Banjara Hills, Hyderabad, 500034, Telangana, India.
J Interv Med. 2021 Dec 10;5(1):10-14. doi: 10.1016/j.jimed.2021.12.004. eCollection 2022 Feb.
To compare the safety of conventional transarterial chemoembolization (cTACE) vs drug-eluting bead TACE (DEB-TACE) in very early- and early-stage hepatocellular carcinoma (HCC).
Data of patients with early- and very early-stage HCC treated with cTACE or DEB-TACE were evaluated retrospectively in this study. A total of 40 patients were included, 20 treated with cTACE and 20 with DEB-TACE. The cTACE and DEB-TACE groups were comprised of 80% and 75% males, while there were 20% females in cTACE group and 25% in Deb-TACE group respectively. The mean age of patients in cTACE group was 57.43 + 5.6 years, while it was 56.4 + 5.5 years in DEB-TACE group. All patients had liver status of Child-Pugh Class A and a score ≤ 7 in Child-Pugh class type B in very early- (stage 0) or early-phase (stage A) stages according to the Barcelona Clinic Liver Cancer (BCLC) system.
The Child-Pugh class degradation in the cTACE group was slightly higher than that in the DEB-TACE group. Serious complications like peritumoral parenchymal ischemia were observed in 4 patients in the cTACE group and 5 in the DEB-TACE group. Localized bile duct dilation was seen in 2 patients in the cTACE group and 6 in the DEB-TACE group.No significant variation in serious complications between the two groups was established in localized bile duct dilatation. Other minor complications noted were liver failure, liver abscess, liver infarction, acute cholecystitis, biliary tree necrosis, and mortality. Further, no substantial variation in tumor response between the groups was reported immediately and 1-year post-procedural assessment. Conversion rate to other treatment modalities such as surgical resection, radiofrequency ablation (RFA), or swap between cTACE and DEB-TACE was substantially higher in the DEB-TACE group (40%) than in the cTACE group (10%) at the 1-year completion period of the study.
In terms of tumor response, the DEB-TACE group showed a better response, to some extent, as an initial therapy for HCC in the early stages as compared to the cTACE group, and DEB-TACE also exhibited better clinical efficacy in patients with HCC.
比较传统经动脉化疗栓塞术（cTACE）与载药微球经动脉化疗栓塞术（DEB-TACE）在极早期和早期肝细胞癌（HCC）中的安全性。
本研究回顾性评估了接受cTACE或DEB-TACE治疗的极早期和早期HCC患者的数据。共纳入40例患者，20例接受cTACE治疗，20例接受DEB-TACE治疗。cTACE组和DEB-TACE组男性分别占80%和75%，cTACE组女性占20%，DEB-TACE组女性占25%。cTACE组患者的平均年龄为57.43±5.6岁，DEB-TACE组为56.4±5.5岁。根据巴塞罗那临床肝癌（BCLC）系统，所有患者的肝脏状态均为Child-Pugh A级，在极早期（0期）或早期（A期）时Child-Pugh B级评分≤7分。
cTACE组Child-Pugh分级的恶化略高于DEB-TACE组。cTACE组有4例患者、DEB-TACE组有5例患者出现了如瘤周实质缺血等严重并发症。cTACE组有2例患者、DEB-TACE组有6例患者出现局限性胆管扩张。两组在局限性胆管扩张方面的严重并发症无显著差异。其他观察到的轻微并发症有肝衰竭、肝脓肿、肝梗死、急性胆囊炎、胆管树坏死和死亡。此外，在术后即刻和1年评估时，两组之间的肿瘤反应未见实质性差异。在研究的1年结束期，DEB-TACE组（40%）转换为其他治疗方式如手术切除、射频消融（RFA）或在cTACE和DEB-TACE之间转换的比例显著高于cTACE组（10%）。
在肿瘤反应方面，与cTACE组相比，DEB-TACE组作为早期HCC的初始治疗在一定程度上显示出更好的反应，并且DEB-TACE在HCC患者中也表现出更好的临床疗效。
