Sanai Faisal M, Alzanbagi Adnan, Arabi Mohammed, Alfawaz Sarah S, Bzeizi Khalid I, Almatrafi Mohammed, Alsabban Abdulmalik M, Bardesi Jameel, Alghamdi Hamdan S, Shawkat Mohamed, Alotaibi Talal M, Alameer Khairat H, Saleem Shadi, Abualganam Saad, Tashkandi Abdulaziz M, Guzaiz Noha H, Abourokbah Nesreen H, Alfakieh Hassan O, Almaghrabi Majed, Alabdullah Abeer A, Aljohani Lujain H, Alqasimi Nuwayyir A, Aldosari Saad, Khankan Azzam, Broering Dieter, Alqahtani Saleh A
Gastroenterology Section, Department of Medicine, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Jeddah 21423, Saudi Arabia.
Liver Disease Research Center, College of Medicine, Riyadh 11461, Saudi Arabia.
Cancers (Basel). 2025 Jul 7;17(13):2254. doi: 10.3390/cancers17132254.
Transarterial radioembolization (TARE) with Yttrium-90 microspheres is an established therapy for unresectable hepatocellular carcinoma (HCC). However, its clinical efficacy compared to transarterial chemoembolization (TACE) remains unclear. We retrospectively reviewed 279 consecutive patients undergoing TARE (n = 104) or TACE (n = 175) at four tertiary centers. Patients with metastatic disease, locally advanced HCC, or Child-Pugh (CP) C were excluded. Data on treatment, adverse events, survival outcomes (median overall survival [mOS], and objective response rates [by modified Response Evaluation Criteria in Solid Tumors; mRECIST]) were collected. The median follow-up of the cohort was 27 months (IQR 13-50), the mean age was 67.6 ± 10.1 years, and 207 (74.2%) were male. The cohort was balanced in age, performance status, CP class, and HCC etiology. Maximum tumor diameter was significantly larger in the TARE cohort compared to the TACE cohort (4.4 vs. 3.1 cm, < 0.001), including within the BCLC 0/A (4.2 vs. 2.7 cm, = 0.001) and BCLC B (5.0 vs. 4.0 cm, = 0.049) subgroups. The mOS was longer with TACE (37 vs. 22 months; hazard ratio [HR] 1.65, 95% CI: 1.19-2.29, = 0.002). In BCLC 0/A patients, TACE yielded longer mOS (60 vs. 25 months; HR 2.35, 95% CI: 1.17-4.69; = 0.016). In BCLC B, mOS was longer with TACE (32 vs. 20 months), but was not statistically significant (HR 1.39, 95% CI: 0.96-2.03, = 0.080). In BCLC 0/A, complete response rates were higher with TACE (43.2% vs. 34.3%, = 0.012). Hepatic decompensation was more frequent with TARE- (26.0%) than with TACE-treated patients (13.7%, = 0.010). TACE demonstrated superior survival outcomes over TARE, particularly in early-stage disease. These results advocate for a more nuanced selection of embolization therapies in these patients.
钇-90微球经动脉放射性栓塞术（TARE）是一种用于不可切除肝细胞癌（HCC）的既定疗法。然而，与经动脉化疗栓塞术（TACE）相比，其临床疗效仍不明确。我们回顾性分析了四个三级中心连续接受TARE（n = 104）或TACE（n = 175）治疗的279例患者。排除有转移性疾病、局部晚期HCC或Child-Pugh（CP）C级的患者。收集了治疗、不良事件、生存结果（中位总生存期[mOS]和客观缓解率[根据实体瘤改良疗效评价标准；mRECIST]）的数据。该队列的中位随访时间为27个月（四分位间距13 - 50），平均年龄为67.6±10.1岁，207例（74.2%）为男性。该队列在年龄、体能状态、CP分级和HCC病因方面均衡。与TACE队列相比，TARE队列的最大肿瘤直径显著更大（4.4 vs. 3.1 cm，<0.001），包括在BCLC 0/A（4.2 vs. 2.7 cm， = 0.001）和BCLC B（5.0 vs. 4.0 cm， = 0.049）亚组中。TACE的mOS更长（37 vs. 22个月；风险比[HR] 1.65，95%置信区间：1.19 - 2.29， = 0.002）。在BCLC 0/A期患者中，TACE的mOS更长（60 vs. 25个月；HR 2.35，95%置信区间：1.17 - 4.69； = 0.016）。在BCLC B期，TACE的mOS更长（32 vs. 20个月），但无统计学意义（HR 1.39，95%置信区间：0.96 - 2.03， = 0.080）。在BCLC 0/A期，TACE的完全缓解率更高（43.2% vs. 34.3%， = 0.012）。TARE治疗的患者肝失代偿比TACE治疗的患者更常见（26.0% vs. 13.7%， = 0.010）。TACE在生存结果方面优于TARE，尤其是在早期疾病中。这些结果支持在这些患者中更细致地选择栓塞治疗方法。
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