Abstract
ObjectivesThis study aims to compare the safety and effectiveness between transarterial chemoembolization (TACE) with drug-eluting beads (DEB-TACE) and conventional TACE (cTACE) using lipiodol-based regimens in HCC patients with a transjugular intrahepatic portosystemic shunt (TIPS).MethodsThis retrospective study included patients with patent TIPS who underwent TACE from January 2013 to January 2019 that received either DEB-TACE (DEB-TACE group, n = 57) or cTACE (cTACE group, n = 62). The complications, liver toxicity, overall survival (OS), time to progression (TTP), and objective response rate (ORR) were compared between the groups.ResultsAltogether, 119 patients (50 ± 11 years, 107 men) were evaluated. The incidence of adverse events, including abdominal pain within 7 days (45.6% vs 79.0%, p < 0.001) and hepatic failure within 30 days (5.3% vs 19.4%, p = 0.027), were significantly lower in the DEB-TACE group than in the cTACE group. Compared to the cTACE group, the DEB-TACE group also showed mild liver toxicities in terms of increased total bilirubin (8.8% vs 22.6%), alanine aminotransferase (5.3% vs 21.0%), and aspartate aminotransferase (10.5% vs 29.0%) levels. The DEB-TACE group had better ORR than the cTACE group (70.2% vs 50.0%). The median OS and TTP were longer in the DEB-TACE group (11.4 vs 9.1 months, hazard ratio [HR] = 2.46, p < 0.001; 6.9 vs 5.2 months, HR = 1.47, p = 0.045). Multivariable analysis showed that α-fetoprotein levels, Barcelona clinic liver cancer stage, and treatment allocation were independent predictors of OS.ConclusionDEB-TACE is safe and effective in HCC patients with a TIPS and is potentially superior to cTACE in terms of complications, liver toxicities, OS, TTP, and ORR.Key Points• DEB-TACE is safe and effective in HCC patients after a TIPS procedure.• DEB-TACE improves overall survival, objective response rate, and liver toxicities and is non-inferior to cTACE in terms of time to progression.• DEB-TACE might be a potential new therapeutic option for HCC patients with TIPS.
Highlights
Hepatocellular carcinoma (HCC) is the most frequent primary liver malignancy and the third leading cause of cancer-related mortality [1]
The eligibility criteria were as follows: (a) age of 18–75 years; (b) HCC diagnosed before Transjugular intrahepatic portosystemic shunt (TIPS) according to the American Association for Liver Disease and European/American Association for Liver Disease guidelines [16, 17]; (c) patients who underwent a TIPS procedure as the secondary prevention of variceal bleeding or refractory ascites; (d) patients who had their first Transarterial chemoembolization (TACE) procedure performed at our institutions and had a patent portal vein vascular perfusion that was exhibited throughout the stent with mid stent Doppler velocity of > 60 cm/s within 1 month after TIPS procedure [18]; (e) Eastern Cooperative Oncology Group (ECOG) performance status score of 0 or 1; and ( f ) Child-Pugh A-B class
TACE may be suitable in a subset of patients [13, 15], this procedure may be associated with increased liver toxicity compared to similar patients without TIPS [14]
Summary
Hepatocellular carcinoma (HCC) is the most frequent primary liver malignancy and the third leading cause of cancer-related mortality [1]. Chemoembolization might lead to hepatic dysfunction and increase liver toxicity, which restricts the usage of TACE in some HCC patients [3]. Besides being a risk factor for the development of HCC, liver cirrhosis predisposes patients to portal hypertension [4]. Transjugular intrahepatic portosystemic shunt (TIPS) is an important treatment strategy in managing portal hypertension complications, including variceal bleeding and refractory ascites [5]. Some HCC patients with portal hypertension treated with TIPS still require treatment for liver malignancy. Conventional TACE (cTACE) can further reduce liver perfusion, which might lead to the increased liver deterioration [6, 7]. The efficacy profile of cTACE in TIPS patients depended on the postprocedural complications [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
