Abstract
PurposeTo investigate whether the iodized oil (Lipiodol, Guerbet Group, Villepinte, France) retention pattern influences the treatment efficacy of combined transarterial Lipiodol injection (TLI) and thermal ablation in patients with hepatocellular carcinoma (HCC).MethodsData of 198 patients (280 HCC lesions), who underwent TLI plus computed tomography (CT)-guided thermal ablation at three separate medical institutions between June 2014 and September 2020, were reviewed and analyzed. The Lipiodol retention pattern was classified as complete or incomplete based on non-enhanced CT at the time of ablation. The primary outcome was local recurrence-free survival (LRFS) for lesions; the secondary outcome was overall survival (OS) for patients. Propensity score matching (PSM) was performed using a caliper width of 0.1 between the two groups. Differences in LRFS and OS between the two groups were compared using the log-rank test.ResultsA total of 133 lesions exhibited a complete Lipiodol retention pattern, while 147 exhibited an incomplete pattern. After PSM analysis of baseline characteristics of the lesions, 121 pairs of lesions were matched. LRFS was significantly longer for lesions exhibiting complete retention than for those exhibiting incomplete retention (P = 0.030). After PSM analysis of patient baseline characteristics, 74 pairs of patients were matched. There was no significant difference in OS between the two groups (P = 0.456).ConclusionLipiodol retention patterns may influence the treatment efficacy of combined TLI and thermal ablation for HCC lesions. However, a survival benefit for the Lipiodol retention pattern among HCC patients was not observed and needs further confirmation.
Highlights
Hepatocellular carcinoma (HCC) accounts for 90% of primary liver cancers and is the fourth most common cause of cancer-related death worldwide
Data for lesion-based variables were collected for each lesion, including the time interval between transarterial Lipiodol injection (TLI) and ablation (≤ 1, > 1 month), TLI alone or transarterial chemoembolization (TACE), modality of thermal ablation (MWA or RFA), tumor size (≤ 3 cm, > 3 cm), watershed tumor, perivascular location, subcapsular location, tumor shape, and tumor vascularity
Results of the present study revealed that hepatocellular carcinoma (HCC) lesions exhibiting a complete Lipiodol retention pattern were associated with a significantly better local recurrence-free survival (LRFS) than those with an incomplete pattern
Summary
Hepatocellular carcinoma (HCC) accounts for 90% of primary liver cancers and is the fourth most common cause of cancer-related death worldwide. For lesions < 3 cm in size, ablation has demonstrated a therapeutic efficacy comparable to surgical resection [3]; for larger tumors, the efficacy of ablation is limited due to insufficient and disproportional ablation zones [4] Various techniques, such as the combination of transarterial chemoembolization (TACE) and ablation, have been proposed to improve the treatment efficacy of ablation for larger tumors [5]. A previous study by Lee et al [8] demonstrated that intra-tumoral Lipiodol accumulation achieved by TACE before ablation may contribute to reducing local tumor progression in intermediate-size (2–5 cm) HCC lesions after ablation. The purpose of the present study was to confirm previous results in a multicenter population and emphasize that tumor visualization can be influenced by the Lipiodol retention pattern, influencing the treatment efficacy of thermal ablation
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