Department of Radiology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea.
Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Korean J Radiol. 2024 Aug;25(8):715-725. doi: 10.3348/kjr.2024.0231.
To evaluate the outcomes of drug-eluting bead transarterial chemoembolization (DEB-TACE) according to the size of the beads for the treatment of small hepatocellular carcinoma (HCC).
This retrospective study included 212 patients with a single HCC ≤5 cm from five tertiary institutions. One hundred and nine patients were treated with 70-150-µm doxorubicin DEBs (group A), and 103 patients received 100-300-µm doxorubicin DEBs (group B). The initial tumor response (assessed between 3 weeks and 2 months after DEB-TACE), time to local tumor progression (TTLTP), restricted mean duration of complete response (RMDCR), rate of complications, incidence of post-embolization syndrome, and length of hospital stay were compared between the two groups. Logistic regression was used to analyze prognostic factors for initial tumor response.
The initial objective response rates were 91.7% (100/109) and 84.5% (87/103) for groups A and B, respectively ( = 0.101). In the subgroup analysis of tumors ≤3 cm, the initial objective response rates were 94.6% (53/56) and 78.0% (39/50) for groups A and B, respectively ( = 0.012). There was no significant difference in the TTLTP (median, 23.7 months for group A vs. 19.0 months for group B; = 0.278 [log-rank], 0.190 [multivariable Cox regression]) or RMDCR at 24 months (11.4 months vs. 8.5 months, respectively; = 0.088). In the subgroup analysis of tumors >3-cm, the RMDCR at 24 months was significantly longer in group A than in group B (11.8 months vs. 5.7 months, = 0.024). The incidence of mild bile duct dilatation after DEB-TACE was significantly higher in group B than in group A (5.5% [6/109] vs. 18.4% [19/103], = 0.003).
DEB-TACE using 70-150-µm microspheres demonstrated a higher initial objective response rate in ≤3-cm HCCs and a longer RMDCR at 24 months in 3.1-5-cm HCCs compared to larger DEBs (100-300-µm).
评估根据微球大小进行载药微球动脉化疗栓塞术（DEB-TACE）治疗小肝细胞癌（HCC）的疗效。
本回顾性研究纳入了来自五家三级医疗机构的 212 例单发 HCC 且肿瘤直径均≤5cm 的患者。109 例患者接受了 70-150-µm 阿霉素 DEB 治疗（A 组），103 例患者接受了 100-300-µm 阿霉素 DEB 治疗（B 组）。比较两组患者的初始肿瘤反应（DEB-TACE 后 3 周至 2 个月之间评估）、局部肿瘤进展时间（TTLTP）、完全缓解限制平均持续时间（RMDCR）、并发症发生率、栓塞后综合征发生率和住院时间。采用 logistic 回归分析初始肿瘤反应的预测因素。
A 组和 B 组的初始客观缓解率分别为 91.7%（100/109）和 84.5%（87/103）（ = 0.101）。在肿瘤直径≤3cm 的亚组分析中，A 组和 B 组的初始客观缓解率分别为 94.6%（53/56）和 78.0%（39/50）（ = 0.012）。两组患者的 TTLTP（中位数，A 组为 23.7 个月，B 组为 19.0 个月； = 0.278[log-rank]，0.190[多变量 Cox 回归]）或 24 个月时的 RMDCR 无显著差异（分别为 11.4 个月和 8.5 个月； = 0.088）。在肿瘤直径>3cm 的亚组分析中，A 组的 24 个月时的 RMDCR 明显长于 B 组（11.8 个月 vs. 5.7 个月， = 0.024）。与 A 组相比，B 组患者在 DEB-TACE 后出现轻度胆管扩张的发生率明显更高（5.5%[6/109] vs. 18.4%[19/103]， = 0.003）。
与较大的微球（100-300-µm）相比，70-150-µm 微球的 DEB-TACE 治疗直径≤3cm 的 HCC 时初始客观缓解率更高，3.1-5cm HCC 时 24 个月时的 RMDCR 更长。
