Outcomes Of Transcatheter Arterial Chemoembolization Research Articles

Anlotinib combined with transarterial chemoembolization for unresectable hepatocellular carcinoma associated with hepatitis B virus: A retrospective controlled study.

e16138 Background: Hepatocellular carcinoma (HCC) has the third-highest cancer-related mortality rate in the world because most patients are diagnosed at an intermediate to advanced stage when surgery is not suitable. Transcatheter arterial chemoembolization (TACE) is currently considered a first-line therapy for unresectable HCC (uHCC), while the efficacy of TACE alone for uHCC patients still needs to be improved. Anlotinib has shown survival benefits in the treatment of uHCC as a kind of novel tyrosine kinase inhibitors (TKIs) in previous studies. Therefore, we aimed to compare clinical outcomes of TACE combined with anlotinib versus TACE monotherapy in patients with uHCC associated with hepatitis B virus (HBV). Methods: We retrospectively collected the data of 96 uHCC patients associated with hepatitis B virus who received either TACE only (TO group; n = 64) or anlotinib combined with TACE (TA group; n = 32) between January 2017 to January 2021. The clinical outcomes including overall survival (OS), progression-free survival (PFS), and tumor response according to mRECIST and RECIST 1.1 were compared between the two groups. Adverse events (AEs) were analyzed to assess the safety profiles. Results: The median OS in the TA group was 17.6 months (95%CI, 11.3 to 24.3) versus 9.4 months (95% CI, 7.8 to 16.3) in the TO group (hazard ratio, 0.59; 95% CI, 0.39 to 0.90; p= 0.018). The median PFS was also significant longer in the TA group (6.7 vs. 3.8months; hazard ratio, 0.46; p< 0.001). Additionally, the objective response rate (ORR) and disease control rate (DCR) numerically increased in the TA group (mRECIST: ORR 65.6% vs. 46.9%, p= 0.064; DCR 90.6% vs. 85.9%, p= 0.382. RECIST 1.1: ORR 46.9% vs. 15.6%, p= 0.001; DCR 90.6% vs. 85.9%, p= 0.382; respectively). No treatment-related mortality occurred. The most common AEs included elevated transaminases (56.3%), decreased appetite (46.9%) and abdominal pain (37.5%) in TA group. Though the incidence rate of grade 3/4 was higher in TA group, all of them were acceptable and controllable. Conclusions: Anlotinib combined with TACE may significantly improve outcomes for uHCC patients associated with hepatitis B virus comparing with TACE monotherapy with a controllable safety profile. Randomized controlled trials with a large sample are warranted to further validate the efficacy.

Clinical Nursing Paths Benefit Patient Outcomes Undergoing Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma.

Objective The purpose of the study is to investigate patient outcomes of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) under clinical nursing paths (CNP) and whether the application of CNP can be a protective factor against the recurrence of HCC. Methods The study comprised of 48 patients who received TACE for HCC under the CNP (assigned into the CNP group) and 41 who received TACE for HCC under the routine care (assigned into the control group). Their treatment safety, pain, and psychology were compared. The nursing satisfaction and quality of life were investigated when patients were discharged from the hospital. A 6-month follow-up was performed to analyze the related factors affecting disease recurrence. Results In the CNP group, the incidence rate of total adverse reactions, VAS scores, SAS and SDA scores were lower, but conversely, the satisfaction and SF-36 scores were higher than those in the control group (P < 0.05). Logistic regression analysis revealed that advanced TNM stage, larger tumor diameter, greater Child-Pugh classification, and the presence of peripheral blood vessel invasion were independent risk factors of HCC recurrence (P < 0.05). Conclusion The study demonstrated that CNP intervention can improve the safety and quality of life of patients undergoing TACE for HCC and reduce their negative emotions and pain feelings, which is worthy of clinical application.

Long-term Outcomes of Transcatheter Arterial Chemoembolization Combined With Radiofrequency Ablation as an Initial Treatment for Early-Stage Hepatocellular Carcinoma

The long-term outcomes of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) are not determined. To report the long-term outcomes of TACE-RFA. This cohort study analyzed long-term follow-up data from a phase 3 randomized clinical trial of adults with early HCC conducted from October 2006 to June 2009. Participants were randomly assigned to the TACE-RFA group or the RFA group in a 1:1 ratio and followed up approximately 6 years after the trial was closed. Data analysis was performed March 2020. In the TACE-RFA group, TACE was performed first, and RFA was done 2 weeks later. Overall survival (OS) and recurrence-free survival (RFS). Of 189 patients who were included (mean [SD] age, 54.3 [12.0] years; 146 [77.2%] men), 94 and 95 patients were assigned to the TACE-RFA group and RFA group, respectively, with their baseline characteristics well matched. Three patients in each group were lost to follow-up. The 5-year and 7-year OS rates for the TACE-RFA group vs the RFA group were 52.0% and 36.4% vs 43.2% and 19.4%, respectively (hazard ratio [HR], 0.55; 95% CI, 0.39-0.78; P = .001). The 5-year and 7-year RFS rates for the TACE-RFA group vs the RFA group were 41.4% and 34.5% vs 27.4% and 18.1%, respectively (HR, 0.66; 95% CI, 0.49-0.89; P = .007). On subgroup analysis comparing patients who had tumors larger than 3 cm with those who had tumors 3 cm or smaller, the OS and RFS survival rates in the TACE-RFA group (HR, 3.20; 95% CI, 1.91-5.35, P < .001) were significantly better than those in the RFA group (HR, 2.03; 95% CI, 1.30-3.17; P = .002). In this cohort study, combined RFA and TACE was associated with better survival than RFA alone on long-term follow-up. Patients with tumors 3 cm or smaller did not benefit as well as patients with tumors larger than 3 cm from the combined treatment.

Transcatheter arterial chemoembolization combined with Hippo/YAP inhibition significantly improve the survival of rats with transplanted hepatocellular carcinoma

BackgroundThis study aimed to explore the effect of inhibiting the Hippo/Yes-associated protein (YAP) signaling pathway on the outcomes of transcatheter arterial chemoembolization (TACE) in treating transplanted hepatocellular carcinoma (HCC).MethodsA transplanted HCC rat model was established. Then, rats were randomly divided into four groups: Sham, TACE, verteporfin (inhibitor of Hippo/YAP), and TACE+verteporfin. Lent-OE-YAP was transfected into rats to overexpress YAP in vivo. After treatments, morphological changes, tumor weight, and the overall survival of rats in different groups were analyzed. Real-time PCR, immunohistochemistry staining, and Western blotting were used to determine the expression of factors related to the Hippo/YAP signaling pathway.ResultsTumor weight and tissue lesions in the TACE and verteporfin groups were significantly reduced compared with the Sham group. Verteporfin significantly decreased tumor weight after TACE treatment. In addition, verteporfin significantly improved the overall survival of rats with transplanted HCC after TACE treatment. Compared with the Sham group, both TACE and verteporfin groups exhibited significantly decreased expression of macrophage-stimulating (MST)1, MST2, long-acting thyroid stimulator 1, transcriptional co-activator with PDZ-binding motif (TAZ), Yes-associated protein (YAP), TEA domain transcription factor (TEAD)1, TEAD2, TEAD3, and TEAD4. TACE plus verteporfin significantly enhanced the downregulation of effectors in the Hippo/YAP signaling pathway and decreased tumor size, while the overexpression of YAP exerted opposite effects.ConclusionThe inhibition of the Hippo/YAP signaling pathway via verteporfin significantly improved the outcomes of TACE in treating transplanted HCC.

Transcatheter Arterial Chemoembolization Combined with Simultaneous Cone-beam Computed Tomography-guided Microwave Ablation in the Treatment of Small Hepatocellular Carcinoma: Clinical Experiences From 50 Procedures

To investigate the technical success, safety and outcomes of transcatheter arterial chemoembolization (TACE) combined with simultaneous cone-beam computed tomography (CBCT)-guided microwave ablation (MWA) in small hepatocellular carcinoma (SHCC). Retrospective analysis of 66 lesions in 50 patients (38 men, 12 women) who underwent TACE combined with simultaneous CBCT-guided MWA for SHCC. After 1 month of treatment, the tumor responses were assessed using the mRECIST criteria, along with interventional-related complications and changes in hepatic and renal function. Moreover, progression-free survival (PFS) and overall survival (OS) were calculated. All patients achieved technical success. The mean target tumor size was 3.4 ± 0.7 (range, 2.2-4.9) cm. The mean energy, ablation duration per tumor, and the mean safety margin were 51.3 ± 8.4 kJ, 6.7 ± 0.8 minutes and 1.4 ± 0.6 cm, respectively. The 1-, 3-, and 5-year PFS rates were 90.0%, 65.4%, and 35.7%, respectively, with a mean PFS of 43.46 months; and the 1-, 3-, and 5-year OS rates were 98.0%, 89.8%, and 74.3%, respectively, with a mean OS of 54.90 months. Multivariate Cox regression analysis further illustrated that TACE combined with MWA in the treatment of a single tumor with a diameter of less than 3 cm was an independent protective factor for PFS and OS (p < 0.001). The patients had no major complications. Among the exceptions, one patient (2%) had an asymptomatic perihepatic effusion that resolved spontaneously, two patients (4%) developed massive right pleural effusion, requiring thoracic drainage, and another patient (2%) developed a hepatic subcapsular hemorrhage required interventional embolization. CBCT-guided TACE combined with simultaneous MWA was a safe and successful treatment of SHCC with a high technical efficacy.

High Epithelial Cell Adhesion Molecule–Positive Circulating Tumor Cell Count Predicts Poor Survival of Patients with Unresectable Hepatocellular Carcinoma Treated with Transcatheter Arterial Chemoembolization

PurposeTo assess the role of epithelial cell adhesion molecule (EpCAM)–positive circulating tumor cell (CTC) count in predicting survival outcomes of transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma (HCC). Materials and MethodsEpCAM-positive CTC counts were prospectively determined via CellSearch in peripheral blood of 97 patients with unresectable HCC treated with chemoembolization. The impact of each CTC cutoff point on overall survival (OS) was evaluated by univariate Cox regression analysis. Based on hazard ratio, patients were divided into 3 groups with low (CTC count 0/1), moderate (CTC count 2–5), and high (CTC count ≥ 6) levels. Correlation of CTC counts with survival was assessed by Cox proportional-hazards model. ResultsEighty-nine patients met inclusion criteria and were enrolled. On multivariate Cox regression analysis, CTC count was found to be an independent predictor of OS (P = .049) and progression-free survival (PFS; P = .007) in patients treated with chemoembolization. After adjustment for confounding factors, mortality risks in the high- and moderate-level groups were 2.819 times (95% confidence interval [CI], 1.218–6.526; P = .016) and 1.301 times (95% CI, 0.630–2.685; P = .477) greater, respectively, than in the low-level group. The risk of progression was 3.705 fold higher in the high-level group (95% CI, 1.628–8.433; P = .002) and 1.648 fold higher in the moderate-level group (95% CI, 0.843–3.223; P = .144) vs the low-level group. ConclusionsHigh EpCAM-positive CTC count predicts poor survival of patients with unresectable HCC treated with chemoembolization.

3:36 PM Abstract No. 275 ■ FEATURED ABSTRACT EpCAM-positive circulating tumor cells independently predict poor outcomes of transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma

To assess the role of epithelial cell adhesion molecule (EpCAM)-positive circulating tumor cell (CTC) count in predicting outcomes of transcatheter arterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC). EpCAM-positive CTC counts were prospectively determined in peripheral blood of 97 patients with unresectable HCC treated with TACE, using CellSearch system. The impact of each cutoff point (each CTC value) on overall survival (OS) was evaluated by the univariate Cox regression analysis. Based on the hazard ratio (HR), the patients were divided into 3 groups: low risk (CTC = 0 and 1), moderate risk (CTC = 2-5) and high risk (CTC≥6) groups. Cox proportional hazards model was used to assess the correlation of CTC counts with outcomes. Eighty-nine patients were enrolled in this study according to patient-selection criteria. The low risk group was used as the control group for univariate Cox analysis. Mortality risk in the high risk and moderate risk groups was 4.164 (95% Confidence Interval [CI], 2.042-8.492, P = 0.000) and 1.695 (95%CI, 0.883-3.253, P = 0.113) times higher, respectively, than that in the low-risk group. On multivariate Cox regression analysis, CTC count was found to be an independent predictor of OS (P = 0.049) and progression-free survival (PFS) (P = 0.007) in patients treated with TACE. After adjustment for confounding factors, the mortality risk in the high risk and moderate risk groups was 2.819 times (95%CI, 1.218-6.526, P = 0.016) and 1.301 times (95%CI, 0.630-2.685, P = 0.477) higher than that in the low risk group. EpCAM-positive CTC count can independently predict poor outcomes of TACE in patients with unresectable HCC.

GALNT14 genotype effectively predicts the therapeutic response in unresectable hepatocellular carcinoma treated with transcatheter arterial chemoembolization.

Transcatheter arterial chemoembolization is currently the standard treatment in hepatocellular carcinoma patients with Barcelona Clinic Liver Cancer stage B. Genomic variants of GALNT14 were recently identified as effective predictors for chemotherapy responses in Barcelona Clinic Liver Cancer stage C patients. We investigated the prognosis predictive value of GALNT14 genotypes in 327 hepatocelluar carcinoma patients treated by transcatheter arterial chemoembolization. Cox proportional hazards model analysis showed that the genotype 'TT' was associated with shorter time-to-response (multivariate p < 0.001), time-to-complete-response (p = 0.004) and longer time-to-tumor progression (p < 0.001), compared with the genotype 'non-TT'. In patients with albumin <3.5 g/dl, genotype 'TT' was associated with longer overall survival (p = 0.027). Finally, genotype 'TT' correlated with higher cancer-to-noncancer ratios of GALNT14 protein levels, lower cancer-to-noncancer ratios of antiapoptotic cFLIP-S, and a clustered glycosylation pattern in the extracellular domain of death receptor 5. GALNT14 genotypes were significantly associated with clinical outcomes of transcatheter arterial chemoembolization. The differential status of extrinsic apoptotic signaling between cancerous and non-cancerous tissues might underlie the clinical association.

Long-term outcome of transcatheter arterial chemoembolization after radiofrequency ablation as a combined therapy for Chinese patients with hepatocellular carcinoma

Objective:This study was undertaken to assess the long-term outcome of transcatheter arterial chemoembolization (TACE) after radiofrequency ablation (RFA) combined with a combined therapy for Chinese patients with intermediate (stage B) hepatocellular carcinoma (HCC) of single block type, and evaluate the survival rate for 1, 3, 5, and 7 years.Research design and methods:This prospective, single-center study consisted of patients with solitary massive intermediate (stage B) HCC treated by RFA combined with TACE from October 1999 to December 2013.Main outcome measures:The survival rate of the patients for 1, 3, 5, and 7 years, and safety of the RFA treatment in the interim, total RFA for each case, and number of TACE cycles were evaluated.Results:Ninety-three patients (aged 54.4 ± 8.0 years) underwent RFA combined with TACE as a combined therapy, and they were analyzed and followed up until December 2013. The mean time for the initial ablation was 1.5–3 h, and, on average, each patient received 1.39 RFA and 1.43 TACE therapies. Overall, complete ablation was achieved in nine patients, and the majority of ablation was seen in 84 patients. The longest survival time was 102 months and, among the survivors the 1, 3, 5, and 7 year survival rate was 94.4%, 52.3%, 26.1%, and 14.1%, respectively. The median survival time was 36 months (95% confidence interval = 32.7–39.3). Serum alpha-fetoprotein (AFP) levels showed significant correlation with tumor size in patients with HCC (r = 0.323, p = 0.0001). There were no major complications related to this therapy.Conclusion:This was the first study that performed RFA combined with TACE in Chinese patients with intermediate (stage B) HCC. RFA combined with TACE, as a combined therapy for intermediate (stage B) HCC, seems to be a promising regimen that showed a satisfactory clinical effect, which may become a new therapy mode for HCC. However, a larger cohort and control group(s) reflecting usual standards of care are needed to assess the external validity of these results in a wider population.

Hepatic Arterial Infusion Chemotherapy for Patients with Huge Unresectable Hepatocellular Carcinoma

Background and AimThe optimal treatment for huge unresectable hepatocellular carcinoma (HCC) remains controversial. The outcome of transcatheter arterial chemoembolization (TACE) for patients huge unresectable HCC is generally poor and the survival benefit of TACE in these patients is unclear. The aim of the study is to compare the effect of hepatic arterial infusion chemotherapy (HAIC) versus symptomatic treatment in patients with huge unresectable HCC.MethodsSince 2000 to 2005, patients with huge (size >8cm) unresectable HCC were enrolled. Fifty-eight patients received HAIC and 44 patients received symptomatic treatment. In the HAIC group, each patient received 2.4+1.4 (range: 1–6) courses of HAIC. Baseline characteristics and survival were compared between the HAIC and symptomatic treatment groups.ResultsThe HAIC group and the symptomatic treatment group were similar in baseline characteristics and tumor stages. The overall survival rates at one and two years were 29% and 14% in the HAIC group and 7% and 5% in the symptomatic treatment group, respectively. The patients in the HAIC group had significantly better overall survival than the symptomatic treatment group (P<0.001). Multivariate analysis revealed that HAIC was the significant factor associated with the overall survival (relative risk: 0.321, 95% confidence interval: 0.200–0.515, P<0.001). None of the patients died due to immediate complications of HAIC.ConclusionsHAIC is a safe procedure and provides better survival than symptomatic treatment in patients with huge unresectable HCC.

Treatment Outcomes of Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma that Invades Hepatic Vein or Inferior Vena Cava

We aimed to elucidate the treatment outcomes of transcatheter arterial chemoembolization (TACE) and survival-associated factors in hepatocellular carcinoma (HCC) patients with hepatic vein (HV) and/or inferior vena cava (IVC) invasion. The subjects were consecutively enrolled, newly diagnosed HCC patients with HV/IVC invasion who underwent TACE (n = 62) at the Seoul National University Bundang Hospital from May 2003 to October 2012. Clinical characteristics, treatment responses, overall survival, and survival-related factors were analyzed. The mean subject age was 56.6 years, 82.3% were hepatitis B surface antigen-positive, and 76.2% were classified as Child-Pugh class A. The tumor volume was ≥50% of the liver in 64.5% of patients, and 79, 41.9, and 9.7% of patients had accompanying portal vein, IVC, and right atrial invasion, respectively. TACE response rates for primary tumors and tumor thrombi in HV or IVC were 55.6 and 13%, respectively. Median overall survival was 10.9 months (range 0.1-23.0 months). Multivariate analysis showed that Child-Pugh class A (hazard ratio [HR] = 0.31; 95% confidence interval [CI] 0.14-0.72; p = 0.007), tumor volume <50% of liver (HR = 0.31; 95% CI 0.11-0.83; p = 0.019), alpha-fetoprotein (AFP) response (HR = 0.28; 95% CI 0.11-0.69; p = 0.006), and tumor thrombi treatment response (HR = 0.09; 95% CI 0.01-0.77; p = 0.027) were independent survival-related factors. TACE seems effective for HCC with HV/IVC invasion, especially in patients with preserved hepatic function, a treatment response for tumor thrombi, and an AFP response.

Treatment outcomes of transcatheter arterial chemoembolization combined with local ablative therapy versus monotherapy in hepatocellular carcinoma: a meta-analysis

To evaluate the effectiveness comparing the combination of TACE with local ablative therapy and monotherapy on the treatment of HCC using meta-analytical techniques. Randomized controlled trials and clinical studies comparing TACE plus local ablative therapy with monotherapy for HCC were included in this meta-analysis. Response rate, 1-, 2-, 3-, and 5-year survival rate, and overall survival (OS) were analyzed and compared. Eighteen studies included a total of 2,120 patients with HCC 1,071 and 1,049 patients for treatment with combination therapy and monotherapy, respectively. The combination therapy group had a significantly better survival in terms of 1-, 2-, 3-, and 5-year survival rate (RR 1.10, 95 % CI 1.03–1.18, P = 0.005; RR 1.20, 95 % CI 1.10–1.30, P < 0.0001; RR 1.43, 95 % CI 1.18–1.73, P < 0.0001; RR 1.40, 95 % CI 1.22–1.61, P < 0.0001, respectively), OS (HR 0.66, 95 % CI 0.51–0.85, P = 0.001), and response rate (RR 1.54, 95 % CI 1.09–2.18, P = 0.013) than that monotherapy group in patients with HCC. The meta-analysis indicates that the combination of TACE with local ablative therapy was superior to monotherapy in the treatment for patients with HCC.

Risk factors for recurrence after transarterial chemoembolization for early-stage hepatocellular carcinoma

Radiofrequency ablation (RFA) is a standard therapy for the treatment of hepatocellular carcinoma (HCC) with 3 or fewer tumors of up to 3 cm (early-stage HCC); when RFA is unsuccessful or unfeasible, transcatheter arterial chemoembolization (TACE) has often been performed. However, little information about the outcome of TACE for early-stage HCC has been reported and it is hard to decide whether to perform additional treatment following TACE in these difficult conditions. The aim of this study was to determine the risk factors for local or intrahepatic distant recurrence after TACE in early-stage HCC. Among 1,560 newly diagnosed HCC patients who were admitted to Okayama University Hospital, 43 patients with early-stage HCC who received only TACE in at least one nodule were enrolled in this study. We analyzed the risk factors for local and distant recurrence by the Cox proportional hazard model. The local recurrence rates and intrahepatic distant recurrence rates at 3 months, 6 months, and 1 year were 18.6, 33.4, and 61.8%, and 2.8, 2.8, and 34.3%, [corrected] respectively.Among 12 parameters examined as possible risk factors for recurrence, heterogeneous Lipiodol uptake (risk ratio 3.38; 95% confidence interval 1.14-10.60) and high serum des-gamma-carboxy prothrombin (DCP) (2.58; 1.03-7.14) were significantly correlated with local recurrence, and the presence of multiple tumors (10.64; 1.76-93.75) was significantly correlated with intrahepatic distant recurrence. Heterogeneous Lipiodol uptake, high serum DCP, and multiple tumors are risk factors for recurrence in patients with early-stage HCC who have undergone palliative TACE.

Switching the Loaded Agent from Epirubicin to Cisplatin: Salvage Transcatheter Arterial Chemoembolization with Drug-eluting Microspheres for Unresectable Hepatocellular Carcinoma

There is no consensus on switching anticancer agents loaded onto drug carriers in transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). This study aimed to evaluate the safety and clinical outcomes of TACE with cisplatin-loaded microspheres (CLM-TACE) in HCC patients refractory to TACE with epirubicin-loaded microspheres (ELM-TACE). Between February 2008 and June 2010, 85 patients with unresectable HCC refractory to ELM-TACE were enrolled to undergo CLM-TACE. The number of ELM-TACE sessions until judgment of resistance ranged from 1 to 4 (median, 2.1). CLM-TACE was performed using 50-100-μm superabsorbent polymer microspheres loaded with 1mg cisplatin/1mg microspheres together with hepatic arterial infusion of 25mg cisplatin and 500mg 5-fluorouracil per patient. Tumor responses were evaluated by computed tomography according to the European Association for the Study of the Liver criteria. The median number of CLM-TACE treatment sessions was 1.8 (range, 1-5), and the mean total dose of cisplatin per session was 42.8mg (range, 30.0-59.0). After 6months, 3 (3.5%) patients achieved complete response, 31 (36.5%) had partial response, 15 (17.6%) had stable disease, and 36 (42.4%) had progressive disease. The median overall survival and time to treatment failure after initial CLM-TACE were 13.3 and 7.2months, respectively. Overall, 9.4% of patients experienced grade 3/4 adverse events. Switching the loaded agent from epirubicin to cisplatin is a safe, well-tolerated, and efficacious treatment strategy for salvage TACE with drug-eluting microspheres in HCC patients refractory to ELM-TACE.

Experience of the treatment following downstaging of larger hepatocellular carcinomas by transcathetheter hepatic arterial chemoembolization in 58 patients

To evaluate the feasibility of sequential liver resection or liver transplantation following downstaging of larger hepatocellular carcinoma (HCC) by transcatheter arterial chemoembolization (TACE). A retrospective study was conducted. And a total of 58 patients with unresectable larger HCC (diameter > 5 cm) from June 2006 to March 2010 underwent TACE. According the outcomes of TACE, they received liver transplantation (LT, n = 36) and liver resection (LR, n = 22) respectively. The overall survival (OS) and recurrence-free survival (RFS) rates were calculated by the Kaplan-Meier method. The multivariate analyses for the influencing factors were evaluated by the Cox proportional hazard model. The median follow-up period of 58 cases was 22 months and the median survival time 23.57 ± 1.54 months. The 1-, 2-, 3-year OS and RFS rates after LT was 94%, 84% & 73% and 88%, 75% & 64% respectively. The median recurrence time was 12.3 ± 6.4 months (range: 3 - 23). Twenty-eight patients had adequate downstaging to qualify for LT under the Milan criteria. The 1-, 2-, 3-year OS and RFS of the downstaging group was better than those of the non-downstaging group (OS: 96%, 88%, 75% vs 92%, 48%, 48% P = 0.067; RFS: 95%, 95%, 79% vs 76%, 40%, 40% P = 0.002). The 1-, 2-, 3-years OS and RFS after LR was 100%, 64% & 52% and 72%, 49% & 49% respectively. The median recurrence time was 9.3 ± 4.5 months (range: 3 - 23). The long-term results of LT group following TACE were better than those of LR group (OS, P = 0.178; RFS, P = 0.139). The multivariate analyses showed that only pathologic total tumor diameter > 7 cm (P = 0.002, RR = 6.578), microvascular invasion (P = 0.001, RR = 5.737) and poor differentiation (P = 0.048, RR = 4.335) were significantly correlated with tumor recurrence. Sequential liver resection and liver transplantation after downstaging by TACE are feasible for some larger HCCs. And the long-term prognosis is satisfactory.

Abstract No. 196: Transcatheter arterial chemoembolization for hepatocellular carcinoma fed by the right inferior phrenic artery: Clinical outcomes and rare pulmonary complications

Abstract No. 196: Transcatheter arterial chemoembolization for hepatocellular carcinoma fed by the right inferior phrenic artery: Clinical outcomes and rare pulmonary complications

Preliminary study of the transcatheter arterial chemoembolization in combination of percutaneous injection of chemoembolization agent intra-portal vein tumor thrombosis in treatment of primary hepatic carcinoma accompanied by portal vein tumor thrombosis

Objective To assess the therapeutic outcomes of transcatheter arterial chemoembolization combined with percutaneous injection of chemoembolization agent intra-portal vein tumor thrombosis for primary hepatic carcinoma accompanied by portal vein tumor thrombus. Methods Thirty patients with primary hepatic carcinoma accompanied by portal vein tumor thrombosis of type Ⅱ and type Ⅲ were randomly divided into two groups. The Child-Pugh ratings (class A and B) of group A and B were 9 vs 9 (class A) and 5 vs 7 (class B) respectively (χ2 = 0.201, P > 0.05). The constitution of Type Ⅱ and type Ⅲ portal vein tumor thrombus in group A and B were 8 vs 9 and 6 vs 7 respectively (χ2 =0.002, P>0.05). The median values of ALT, TBIL, ALB and AFP in group A and B were 58.7U/L vs 70.5 U/L (W=191.5, P>0.05), 21.4 μmol/L vs 21.7μmol/L (W=203, P>0.05), 35.3 g/L vs 37.5 g/L (W = 214, P > 0.05) and 680 μg/L vs 873 μg/L (W = 179. 00, P > 0.05) respectively. Group A was treated with transcatheter arterial chemoembolization (TACE) using emulsion made up of adriamycin, cisplatin, mitomycin and ultraliquidlipiodol plus percutaneous injection of chemoembolization agent intra-portal vein tumor thrombosis using emulsion consisted of cisplatin and ultraliquidlipiadol, while group B was treated with TACE only as a control group. Survival analyses were performed via the Kaplan-Meier test in SPSS11.5 with the log-rank tests with an threshold of 0.05. Results The 3, 6 and 12 months survival cases of group A and B were 11 vs 10, 10 vs 3, and 7 vs 0 respectively. The median survival time of group A and group B were 14.0 months and 4.0 months respectively. The difference of the two groups was significantly (χ2 =11.728, P<0.01). There was no severe side-effect related to therapy in both groups. Conclusion Comparing with the control group, TACE combined with percutaneous injection of chemoembolization agent intra-portal vein tumor thrombosis could significantly prolong the median survival time of patient with primary hepatic carcinoma accompanied by type Ⅱ and type Ⅲ portal vein tumor thrombosis. Key words: Liver neoplasms; Neoplasm metastasis; Portal vein; Tumor thrombus; Embolization, therapeutic

Abstract No. 346: Standardized Reporting of Toxicity and Outcome of Transcatheter Arterial Chemoembolization for Unresectable HCC

Abstract No. 346: Standardized Reporting of Toxicity and Outcome of Transcatheter Arterial Chemoembolization for Unresectable HCC

Radiofrequency ablation of unresectable liver metastases.

The most common hepatic metastasis among adults in the United States is from colorectal cancer, the fourth most frequent malignancy, with approximately 130,200 new cases expected in 2000. Liver metastasis will develop within 5 years of initial diagnosis in about half these patients, and approximately 20% will, at first, have no extrahepatic metastases. Note also that the liver is the sole metastatic site in about 25% of deaths from colorectal cancer. Pancreatic neuroendocrine tumors are the second most common origin of metastasis confined to the liver. Other cancers, such as those of the lung, breast, stomach, and cutaneous melanoma, usually disseminate simultaneously to the liver and multiple other visceral sites. Occasionally, gastrointestinal sarcoma or ocular melanoma and, more rarely, renal cell carcinoma, Wilms’ tumor, or breast cancer, may initially metastasize to the liver alone. Survival of patients with liver metastasis is poor, but it depends on the extent of liver involvement at diagnosis and on the presence or absence of extrahepatic dissemination. Historical data suggest that, with palliative care only, 20% to 30% of patients survive 3 years after detection of a single colorectal metastasis to the liver. Local therapies, such as surgical resection or physical ablation, usually are indicated only when there is no evidence of extrahepatic spread. The prognosis is somewhat better for the 10% to 30% of patients with liver metastasis who are eligible for surgery. Median survival was 24 to 42 months and survival at 5 years was 25% to 37% in retrospective series of patients resected for liver metastasis after complete excision of the primary tumor. Prognostic factors for recurrence after resection of hepatic metastasis include the presence of four or more lesions, tumor-free margins less than 1 cm, and elevated serum levels of carcinoembryonic antigen. Surgery is precluded for most patients with hepatic metastasis, either by the anatomic location, size, or number of lesions; by inadequate viable liver tissue that would remain after operation; or by comorbid conditions. Treatment options are limited for these patients. Percutaneous ethanol injection, used frequently outside the United States for hepatocellular carcinoma, appears less effective for liver metastasis, so is used infrequently. In the United States, most patients with inoperable liver metastasis are offered chemotherapy with fluorouracil or floxuridine, alone or with folinic acid (leucovorin). These drugs can be given systemically or by hepatic artery infusion and can be combined with other drugs such as doxorubicin, mitomycin, cisplatin, or, more recently, irinotecan or oxaliplatin. Chemotherapy may also be used as an adjunct to surgery when histology shows the margins are not free of tumor. Local ablative therapies using radiofrequency thermotherapy or cryosurgery have been introduced more recently. Transcatheter arterial chemoembolization (TACE), an older technique, has been used for patients with more extensive disease. But TACE is used more commonly for patients with primary hepatocellular carcinoma than for those with hepatic metastases, and substantially more data have been reported on outcomes of TACE for hepatocellular carcinoma than for hepatic metastases. This is a systematic review of evidence on the outcomes of radiofrequency ablation for treatment of inoperable liver metastases after complete excision of the primary tumor. Outcomes of interest are overall survival, diseaseor symptom-free survival, palliation, and adverse effects of treatment. Two uses of radiofrequency ablation are considered: used alone, and used in combination with resection or other therapies. Each is inNo competing interests declared.

Long-term outcomes of transcatheter arterial chemoembolization with autologous blood clot for unresectable hepatocellular carcinoma

Ninety-two consecutive patients with unresectable hepatocellular carcinoma (HCC) greater than 2 cm and less than 5 cm in diameter were treated by transcatheter arterial chemoembolization using autologous blood clot as an embolizing agent (Short-TAE; S-TAE). Survival, patency of hepatic arteries and side effects were retrospectively analyzed. The median follow-up interval was 42 months. The median size of the main tumor was 3.4 cm in diameter. All tumors were determined to be inoperable because of intrahepatic spread of tumors and/or poor hepatic functional reserves. S-TAE was performed by injecting a mixture of iodized oil and anticancer drugs followed by embolization of hepatic arteries with autologous blood clot. Embolization with clots maintained patency of hepatic arteries in all the patients. The overall survival rates for 92 HCC patients at 1, 3, 5, 7 and 8 years were estimated by the Kaplan-Meier method to be 100, 52, 34, 12 and 6%, respectively, which were better compared with prior records for conventional method with gelfoam. S-TAE was successfully performed in 16 patients with Childs class C liver cirrhosis presenting icterus and ascitis. The survival rates for Childs class C patients at 1, 2 and 3 years were 100, 66 and 32%, respectively. The Cox proportional hazard model was used to assess influence of each pretreatment parameter (age, gender, virus marker, stage of cirrhosis, number of tumor) on survival. The univariate analysis demonstrated that both the stage of cirrhosis and the multiplicity of tumor were significant factors predicting survival (p=0.003 and 0.046, respectively). The multivariate analysis showed the stage of cirrhosis to be the sole factor which significantly affected prognosis of HCC patients (p=0.005). In conclusion, chemoembolization with autologous blood clot is an effective and safe therapeutic option for unresectable HCC smaller than 5 cm. The hepatic functional reserves play a key role in determining prognosis of HCC patients.