Advanced Hepatocellular Carcinoma With Hepatic Arterioportal Shunts: Combination Treatment of Transarterial Chemoembolization With Apatinib.

Tao Sun,Yanqiao Ren,Fan Yang,Xuefeng Kan,Lei Chen,Weihua Zhang,Chuansheng Zheng

doi:10.3389/fmolb.2020.607520

Abstract

Object: This study aimed to compare the efficacy and safety of transarterial chemoembolization (TACE) combining with apatinib (TACE-apatinib) and TACE-alone for patients with advanced hepatocellular carcinoma (HCC) with hepatic arterioportal shunts (APS).Materials and Methods: This retrospective study evaluated the medical records of patients with advanced HCC with APS who underwent TACE-apatinib or TACE-alone from June 2015 to January 2019. The occlusion of the shunt was performed during the TACE procedure. The time to tumor progression (TTP) and overall survival (OS) of study patients were evaluated. The modified Response Evaluation Criteria in solid tumors (mRECIST) was used to evaluate the treatment response. The apatinib-related adverse events were recorded.Results: Fifty-eight patients were included in this study. Twenty-seven patients underwent the treatment of TACE-apatinib, and 31 received TACE-alone treatment. The median overall survival (OS) and median time of tumor progression (TTP) in the TACE-apatinib group were significantly longer than those of the TACE-alone group (OS: 12.0 vs. 9.0 months, P = 0.000; TTP: 9.0 vs. 5.0 months, P = 0.041). Multivariate analysis revealed that TACE-apatinib was a protective factor for OS, and there was no independent risk factor for TTP. In the TACE-apatinib group, the grade 3 apatinib-related adverse events occurred in four patients.Conclusion: TACE-apatinib was an efficacious and safe treatment for patients with advanced HCC with APS, and apatinib improved the efficacy of TACE in the treatment of these patients.

Highlights

Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and is one of the most prevalent causes of tumor-related death (Bray et al, 2018)
arterioportal shunts (APS) can affect the safety of transcatheter arterial chemoembolization (TACE), as lipiodol can flow through the fistula and thereby access normal hepatic and pulmonary tissues (Ziessman et al, 1984)
The inclusion criteria for this study were as follows: (1) patients were diagnosed with HCC based on the guidelines of the European Association for the Study of Liver or the American Association for the Study of Liver Disease; (2) patients were staged at Barcelona Clinic Liver Cancer (BCLC)-C in accordance with the BCLC system; (3) patients were diagnosed with APS via medical imaging; (4) patients with liver function graded at Child-Pugh A or B; (5) patients had the Eastern Cooperative Group Performance Status (ECOG) score of patients were 0–2

Summary

Introduction

Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and is one of the most prevalent causes of tumor-related death (Bray et al, 2018). About 35–40% of all HCC patients are diagnosed when the disease has reached an advanced stage (Barcelona Clinic Liver Cancer [BCLC] stage C) owing to an absence of routine screening protocols and to the fact that the disease is often asymptomatic in its early stages, limiting patient treatment options (Forner et al, 2010). These patients must rely on palliative therapies, such as sorafenib treatment to prolong their survival (Forner et al, 2010). The standard treatment of APS relies upon the blocking of these shunts using an appropriate embolic material, which can be carried out via the TACE procedure (Kim et al, 2007)

Objectives

Methods

Results

Conclusion