Sessions Of Transcatheter Arterial Chemoembolization Research Articles

Double closed loop small bowel obstruction due to right diaphragmatic hernia after transcatheter arterial chemoembolization and microwave ablation for hepatocellular carcinoma.

64-Year-old male patient with hepatocellular carcinoma (HCC), liver cirrhosis, chronic hepatitis C infection, and glottic cancer presented with acute progressive abdominal pain and palpable mass in right upper quadrant of the abdomen. Despite treatment with hyoscine and tramadol, the symptoms persisted. He had received three sessions of Transcatheter arterial chemoembolization (TACE) and two sessions of microwave ablation (MWA) for HCC treatment, with the last session being TACE 11months prior. Plain film abdomen showed bowel gas pattern in the right hemithorax compatible with bowel obstruction. CT imaging revealed a right diaphragmatic hernia containing closed loop small bowel obstruction. An emergency exploratory laparotomy was performed. The patient improved and was discharged. There was no recurrence of diaphragmatic hernia or abdominal mass or pain at the 6-month follow-up visit. We herein demonstrate a catastrophic complication of TACE by using an IPA and MWA which leads to right diaphragmatic hernia.

History of Transcatheter Arterial Chemoembolization Predicts the Efficacy of Hepatic Arterial Infusion Chemotherapy in Hepatocellular Carcinoma Patients.

This study sought to identify factors that are predictive of a therapeutic response to hepatic arterial infusion chemotherapy (HAIC) by focusing on the number of prior transcatheter arterial chemoembolization (TACE) sessions. To determine the parameters predicting a good response to HAIC, we retrospectively analyzed 170 patients with hepatocellular carcinoma (HCC) who received HAIC regimens comprising low-dose cisplatin combined with 5-fluorouracil (LFP) or cisplatin (CDDP) for the first time. In both the LFP and CDDP regimens, the response rates were significantly lower in patients with three or more prior TACE sessions than in those with two or fewer prior TACE sessions (LFP 57% versus 28%; p=0.01, CDDP 27% versus 6%; p=0.01). Multivariable logistic regression analysis revealed that the number of prior TACE sessions (≥ 3) was significantly associated with non-responder status (odds ratio 4.17, 95% Confidence Interval (CI) 1.76-9.86) in addition to the HAIC regimen. Multivariable analysis using the Cox proportional hazards model revealed that a larger number of prior TACE sessions (≥ 3) was a significant risk factor for survival (hazard ratio 1.60, 95% CI 1.12-2.29) in addition to Child-Pugh class, serum alpha-fetoprotein concentration, and maximum diameter of HCC. HCC patients who receive fewer prior TACE sessions (≤ 2) were found to be better responders to HAIC.

Transcatheter arterial chemoembolizationplus atezolizumab and bevacizumab for unresectable hepatocellular carcinoma: a single-arm, phase II trial.

The therapeutic effect of transcatheter arterial chemoembolization (TACE) is limited for patients with hepatocellular carcinoma (HCC). Herein, we designed an open-label, single-arm phase II clinical trial to investigate the efficacy and safety of TACE combined with atezolizumab plus bevacizumab for patients with Barcelona Clinic Liver Cancer (BCLC) stage-B HCC. Patients will initially receive TACE. Atezolizumab and bevacizumab will be initiated 2-14days after the first TACE session. TACE will be repeated on demand. The primary endpoint is the objective response rate. The secondary end points include overall survival, disease control rate, progression-free survival, time-to-progressionand safety. The study results will provide evidence for establishing a novel therapeutic regimen for patients with unresectable HCC. Clinical Trial Registration: ChiCTR2100049829 (ChiCTR.org).

Microvascular invasion may be the determining factor in selecting TACE as the initial treatment in patients with hepatocellular carcinoma.

The aim of this study was to investigate factors affecting tumor necrosis with transcatheter arterial chemoembolization (TACE). Factors associated with early hepatocellular carcinoma recurrence after curative hepatectomy were also evaluated.Data of 51 patients who underwent surgery after a single session of TACE at a single university hospital were retrospectively analyzed. Factors that might affect tumor necrosis were determined by evaluating the TACE approach and by analyzing computed tomography and TACE findings, pathologic reports, and laboratory findings.In univariate analysis, microvascular invasion (MVI), radiological capsule appearance on the computed tomography, chronic hepatitis B, diabetes mellitus and serum albumin, MVI were significantly associated with tumor necrosis by TACE (P < .02). In multivariate analysis, MVI was the only statistically significant factor in TACE-induced tumor necrosis (P = .001). In univariate and multivariate analysis, MVI was the strongest factor for recurrence-free survival rate within 2 years (P = .008, P = .002).MVI could be a crucial factor in determining TACE as an initial treatment for hepatocellular carcinoma. MVI is also a strong indicator of recurrence within 2 years after curative hepatic resection.

TACTICS: Final overall survival (OS) data from a randomized, open label, multicenter, phase II trial of transcatheter arterial chemoembolization (TACE) therapy in combination with sorafenib as compared with TACE alone in patients (pts) with hepatocellular carcinoma (HCC).

270 Background: To date many trials have been conducted to compare the efficacy and toxicity between TACE plus molecular targeted agents and TACE alone; all of them failed to show its clinical benefit in terms of progression free survival (PFS) or OS. In TACTICS trial (NCT01217034) TACE plus sorafenib significantly improved PFS over TACE alone in patients with unresectable HCC. ( Gut 2020;69:1374-1376). Here we will report a final OS analysis from TACTICS trial with predefined mature OS events. Methods: Patients with unresectable HCC were randomized to TACE plus sorafenib (n=80) or TACE alone (n=76). Patients in the combination group received sorafenib 400 mg once daily for 2–3 weeks before TACE, followed by 800 mg twice daily during on-demand conventional TACE sessions until time to untreatable (unTACEable) progression (TTUP), defined as untreatable tumor progression, transient deterioration to Child-Pugh C or appearance of vascular invasion/extrahepatic spread. Co-primary endpoints were progression-free survival (PFS), which is defined as TTUP, or time to any cause of death and OS. Multiplicity was adjusted by gatekeeping hierarchical testing. Results: At the cut-off date of July 31, 2020, 131 OS events were observed. Median OS was 36.2 mo with TACE plus sorafenib vs 30.8 mo with TACE alone (HR, 0.861 [95%CI, 0.607, 1.223]; P=0.40). ΔOS was 5.4 mo. Updated PFS was 22.8 mo with TACE plus sorafenib vs 13.5 mo with TACE alone (HR, 0.661[95%CI, 0.466, 0.938]; P=0.02). Post-trial treatments with active procedures/agents were observed in 47 (58.8%) in TACE plus sorafenib and in 58 (76.3%) with TACE alone. Anticancer procedures in TACE alone group include resection/ablation in 14, transarterial therapy in 53 and radiation in 7. Anticancer medications in TACE alone include targeted agents in 40 (29 sorafenib, 5 regorafenib, 3 lenvatinib, 3 ramucirumab), other systemic chemotherapy in 5 and immunotherapy in 5. Safety was consistent with the primary analysis, with no new signals identified. Conclusion: In TACTICS, TACE plus sorafenib did not show OS benefit as compared with TACE alone although significantly better PFS was consistently observed. OS in TACE plus sorafenib in TACTICS trial showed the longest OS (36.2 mo) with the longest ΔOS (5.4 mo) as compared with the previous 5 TACE combination trials. The major reason for negative OS result was speculated that many post-trial active treatments were performed in control arm (76.3%), which implies that OS endpoint in TACE combination trial may not be feasible anymore in current era of sequential therapy with many active locoregional and systemic treatments. Clinical trial information: NCT01217034.

Management of intermediate‐stage hepatocellular carcinoma in the elderly with transcatheter arterial chemoembolization failure: Retreatment or switching to systemic therapy?

Transcatheter Arterial chemoembolization (TACE) is the first-line option for the intermediate-stage hepatocellular carcinoma. Guidelines do not define the number of TACE sessions to be repeated before stopping treatment and switching to sorafenib. We retrospectively analysed 76 patients aged ≥65years who were treated by multiple TACE sessions (re-TACE group; N=36 patients) or one TACE session followed by sorafenib (TACE/Sorafenib group; N=40 patients). The primary outcome was the overall survival (Kaplan-Meier analysis and log-rank test). Median overall survival was 320days (range: 70-420days) in re-TACE subgroup and 285days (range: 50-368days) in TACE/Sorafenib subgroup without significant differences between the two groups (log-rank test P=.72; HR=0.87; 95% IC 0.41-1.87). The survival rate at one year was 43.6% and 32% in the re-TACE and in the TACE/sorafenib groups (P=.12), respectively. Subgroup analysis by gender, number of nodules at baseline and etiology of liver cirrhosis was performed but no differences were found. No statistical difference was observed in the frequency of side effects, but sorafenib was associated with severe diarrhoea in most patients requiring dose reduction. In our study including HCC patients aged ≥65years, no differences in survival rate and side effects were found between patients Retreated with further TACE sessions and patients with treatment stage migration to sorafenib after first TACE failure. We included in our analysis a small study population; therefore, larger prospective studies are needed to confirm these findings.

Hepatocellular Carcinoma With Different Areas of Right Retroperitoneal Space Invasion: Evaluation of Transcatheter Arterial Chemoembolization Efficacy and Blood Supply Characteristics.

PurposeTo evaluate the therapeutic efficacy of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with different areas of right retroperitoneal space (rRPS) invasion and analyze the blood supply.MethodsThis retrospective study enrolled 41 patients with HCC with different areas of rRPS invasion treated with TACE, including 22 HCCs with superior aspect of the right perirenal space (SARPS) invasion and 19 HCCs with right anterior pararenal space (RAPS) invasion. The overall response rate (ORR) and disease control rate (DCR) were analyzed. The prognostic factors for overall survival (OS) after TACE were determined. The blood supply characteristics of HCC with different areas of rRPS invasion were analyzed with arteriograms.ResultsAll patients underwent 2.8 ± 1.8 TACE sessions over 25.0 ± 21.9 months. The median OS was 29.0 months for patients with SARPS invasion and 12.0 months for patients with RAPS invasion (P = 0.004). Only the invaded area of the rRPS was an independent prognostic factor for OS [hazard ratio (HR), 2.833; 95% CI, 1.297–6.188; and P = 0.009). The ORR and DCR were significantly higher in the group with SARPS invasion than in the group with RAPS invasion (ORR: 63.6% vs 31.6%, P = 0.041; DCR: 77.3% vs 47.4%, P = 0.047). Initially, HCC with SARPS invasion were supplied by the hepatic artery (HA; n = 8) and both the HA and extrahepatic collateral vessels (EHCs; n = 14); HCC with RAPS invasion were supplied by the HA (n = 10) and both the HA and EHCs (n = 9); as the TACE sessions increased, the tumor-feeding vessels shifted from the HA to both the HA and EHCs, and even EHCs could be the only blood supply. Rare EHCs appeared earlier and more frequently in the RAPS group than in the SARPS group.ConclusionThe efficacy of TACE differed for HCC with different areas of rRPS invasion, and the median OS, ORR and DCR were significantly better in the SARPS group than in the RAPS group. Different common EHCs supplied HCCs with different areas of rRPS invasion, while other rare EHCs appeared more frequently in the RAPS group.

A novel pretreatment model identifying high-risk of refractoriness after transcatheter arterial chemoembolization in unresectable hepatocellular carcinoma.

e16641 Background: Refractoriness to transcatheter arterial chemoembolization is common during the therapeutic process of hepatocellular carcinoma, which is an intractable issue and may compromise the prognosis. We aim to establish a pre-treatment model to identify patients with high risks of refractoriness. Methods: From 2010 to 2016, 824 patients who had initially underwent at least two sessions of transcatheter arterial chemoembolization in Zhongshan Hospital, Fudan University were retrospectively enrolled. These patients were randomly allocated into a training cohort and a validation cohort. The pre-treatment scoring model was established based on the clinical and radiological variables using logistic regression and nomogram. The discrimination and calibration of the model were also evaluated. Results: Logistic regression identified vascularization pattern, ALBI grade, serum alpha-fetoprotein level, serum γ- glutamyl transpeptidase level and major tumor size as the key parameters related to refractoriness. The p-TACE model was established using these variables (risk score range: 0-19.5). Patients were divided into six risk subgroups based on their scores ( &lt; 4, ≥4, ≥7, ≥10, ≥13, ≥16). The discriminative ability, as determined by the area under receiver operating characteristic curve was 0.784 (95% confidence interval: 0.741-0.827) in the training cohort and 0.743 (95% confidence interval: 0.696-0.789) in the validation cohort. Moreover, satisfactory calibration was confirmed by Hosmer-Lemeshow test with P values of 0.767 and 0.913 in the training cohort and validation cohort. Conclusions: This study presents a pre-treatment model to identify patients with high risks of refractoriness after transcatheter arterial chemoembolization and shed light on clinical decision making.

Incidence and risk factors of contrast-induced nephropathy after transcatheter arterial chemoembolization in hepatocellular carcinoma.

Transcatheter arterial chemoembolization (TACE) is widely used for unresectable hepatocellular carcinoma (HCC). The purpose of this study was to investigate incidence and risk factors of contrast-induced nephropathy (CIN) after TACE in patients with HCC. In this single-center retrospective study, we examined 461 consecutive TACE sessions in 260 patients between January 2003 and October 2015. CIN was defined as an increase in serum creatinine levels by ≥ 0.5mg/dl or ≥ 25% from baseline within 72h after TACE. We calculated incidence rate of CIN and tried to identify its risk factors by logistic regression analysis. Twenty-one cases of CIN (5%) were observed in 461 TACE sessions. One patient required subsequent hemodialysis transiently. In univariate analysis, tumor size > 5cm [odds ratio (OR) 5.76, 95% confidence interval (CI) 2.34-14.14, p < 0.001], chronic kidney disease (OR 2.54, 95% CI 1.05-6.14, p = 0.04), serum hemoglobin level [OR 0.79 (per 1g/dl increase), 95% CI 0.64-0.98, p = 0.03] and serum albumin level [OR 0.44 (per 1g/dl increase), 95% CI 0.19-1.02, p = 0.05] were associated with the development of CIN. Stepwise logistic regression methods showed that tumor size > 5cm (OR 7.81, 95% CI 2.99-20.46, p < 0.001) and serum albumin [OR 0.29 (per 1g/dl increase), 95% CI 0.11-0.75, p = 0.01] were risk factors of CIN. In this study, HCC tumor size and lower serum albumin level were independent predictors of CIN after TACE.

Establishment of a predictive model for short-term efficacy of transcatheter arterial chemoembolization treatment in hepatocellular carcinoma and its clinical application.

This study aimed to establish a predictive model for the presence of transcatheter arterial chemoembolization (TACE) resistance in hepatocellular carcinoma (HCC) Barcelona Clinic Liver Cancer classification stage B or stage C4 (BCLC B/C) and further verify its accuracy, enabling clinicians to accurately predict the efficacy of TACE and propose individualized therapy to further optimize multidisciplinary team plans. A retrospective database review was performed, including 191 patients (39 females and 152 males; aged 50-76 years with a mean age of 55 ± 10 years) who received three consecutive TACE sessions for treating HCC (BCLC B/C) in 1 month apart, for a total of 3 months. After three TACE treatments, a total of 95 patients among the 191 patients showed TACE resistance, 112 cases were randomly selected to build the modeling group, and the remaining 79 cases formed a verification group. Some prognostic risk factors were obtained through clinical observation. Then, univariate and multivariate analyses were performed using the logistic proportional hazard regression model. Based on multivariate analysis results, a risk-index model was established and its effects on predicting the incidence of TACE resistance of those patients were evaluated. Based on the results of the multivariate analysis, to show that were four-independent factors affecting a prognosis of patients with TACE resistance after three consecutive TACE treatment in 3 months, which were red blood cell (RBC), neutrophil count (NC), model for end-stage liver disease (MELD), and Apoprotein A1. The risk index model established according to the above factors was expressed as a predictive indice (PI), and PI = -3.79 + 4.916 × RBC - 1.547 × NC - 4.142 × MELD + 10.789 × ApoA1. The area under the receiver operating characteristic curves (AUROC) of PI of the modeling group was 0.986, which was significantly higher than that of each component index in the equation. The specificity of the modeling group was 86.3%, and the sensitivity was 70.4%, and 43 of 61 patients with PI ≤ 5.36 (70.5%) had a good outcome 3 months after consecutive TACE. From of the PI, among 51 patients with TACE resistance after consecutive TACE, 32 (62.7%) had a PI > 5.36, and only 19 patients were misidentified as having TACE resistance because of their PI > 5.36. The accuracy was 82.1%. The specificity of the validation group was 85.9%, and the sensitivity was 77.9%. The disease was under control in 29 of the 35 patients with PI ≤ 5.36 (82.9%) after consecutive TACE. According to PI, among the 44 patients with TACE resistence after consecutive TACE, 38 (86.4%) had PI > 5.36, and only 6 patients were misidentified as TACE resistance due to their PI > 5.36, with an accuracy of 87.3%, respectively. According to the PI of this study, we investigated the risk factors and protective factors to estimate the presence of TACE resistance after three consecutive TACE treatment, so as it could help doctors to evaluate the patientet condition and choose more reasonable treatment methods.

Transcatheter arterial chemoembolization monotherapy vs combined transcatheter arterial chemoembolization-percutaneous microwave coagulation therapy for massive hepatocellular carcinoma (≥10 cm).

BackgroundThe prognosis of massive hepatocellular carcinomas (MHCCs; ≥10 cm) remains worse.PurposeThe aim of this study was to evaluate the clinical benefits of transcatheter arterial chemoembolization (TACE) or TACE combined with percutaneous microwave coagulation therapy (PMCT) and the long-term survival rate of MHCC patients treated with these techniques.Patients and methodsA retrospective study was performed using data involving 102 MHCC patients admitted to the Second Hospital of Nanjing from September 2010 to August 2015. The median interval between treatments and overall survival (OS) was hierarchically analyzed using log-rank tests. Multivariate analysis was done using Cox regression model analysis.ResultsThe median survival time of MHCC patients was 3 months (range, 1–10 months) in the palliative group, 3 months (range, 1–39 months) in the TACE group, and 7.5 months (range, 3–30 months) in the TACE–PMCT group (P=0.038). The 6-, 12-, and 18-month OS rates for MHCC patients were 15%, 0%, and 0% in the palliative group, 30%, 25.63%, and 17.97% in the TACE group, and 50%, 41.67%, and 16.67% in the TACE–PMCT group, respectively (P=0.0467). In addition, TACE sessions had positive correlation with the survival time of MHCC patients (rho = 0.462, P<0.001). TACE treatment more than three times (HR =0.145, P<0.001) was an independent predictor of the survival of MHCC patients, which was identified by the Cox regression model analysis.ConclusionsThese results indicated that TACE–PMCT treatment in MHCC patients had advantages in prolonging OS and improving liver function. Multiple TACE treatments might be a suitable treatment for the MHCC patients.

Hepatoduodenal Fistula Successfully Treated With Enteral Metallic Stent: A Rare Complication Following Trans-catheter Arterial Chemoembolization for Hepatocellular Carcinoma

A 62-year-old man presented with fever and right upper quadrant pain (RUQ) for 1 week. He was recently diagnosed with chronic hepatitis B cirrhosis and hepatocellular carcinoma (HCC). He underwent several sessions of transcatheter arterial chemoembolization (TACE) as a palliative treatment. On physical examination, body temperature was 39°C. Marked tenderness was observed at RUQ. Laboratory tests revealed white blood cell count 8.5x109/L (neutrophil 78%), total bilirubin 2.6 mg/dL, aspartate aminotransferase 37 U/L, alanine aminotransferase 21 U/L and alkaline phosphatase 110 U/L. Computed tomography (CT) showed a fistulous connection between gas-containing cavity in previous HCC area, suggesting an abscess draining to duodenum (Figure 1). Esophagogastroduodenoscopy (EGD) was done to confirm the fistula through a 1.5-cm hole in the second part of duodenum (Figure 2A). A few days later, a repeat upper endoscopy was performed with a therapeutic duodenoscope and a partially-covered enteral metallic stent was placed between duodenum and pylorus (Figure 2B). Follow-up CT (1 month after the intervention) showed complete obliteration of the fistulous tract (Figure 3). The remaining liver abscess was treated by percutaneous drainage and antibiotics. The patient was discharged 1 month later with a significant improvement of symptoms.2283_A Figure 1. Contrast-enhanced computed tomography (A) axial view (B) coronal view showed fistulous connection (arrow) between lipiodol-staining mass at hepatic segment V/VII and second part of duodenum.2283_B Figure 2. (A) Endoscopic finding of fistula tract at second part of duodenum with failure of closure by endoscopic clipping (B) Fluoroscopic view showed successful enteral metallic stent deployment.2283_C Figure 3. Contrast-enhanced computed tomography (A) axial view (B) coronal view showed metallic stent at duodenum and improvement of hepatoduodenal fistula.Hepatoduodenal fistula is a rare complication of HCC after TACE. Only few reports have been previously described. Abscess formation from necrotic tumor after TACE with local inflammation may lead to abnormal connection to surrounding structures. A direct invasion from advanced HCC is also another possible cause of fistula formation. There are several therapeutic approaches for managing fistula, including, conservative treatment, endoscopic Histoacryl injection and surgery. However, the selection is depended on the case scenario and the availability of special devices. Herein, we report the first case of hepatoduodenal fistula, which was successfully treated with enteral metallic stent after a failure of endoscopic clipping due to a large fibrotic fistula defect. Although rare, hepatoduodenal fistula is a serious and fatal condition. Clinical suspicion along with radiologic and endoscopic findings are crucial clues for diagnosis. Stent placement can be considered as an alternative to surgery in a large and difficult-to-close fistula tract.

Alpha-fetoprotein response following transarterial chemoembolization indicates improved survival for intermediate-stage hepatocellular carcinoma

BackgroundTo investigate the clinical value of the alpha-fetoprotein (AFP) response following transcatheter arterial chemoembolization (TACE) in intermediate-stage hepatocellular carcinoma (HCC). MethodsData on patients with Barcelona Clinic Liver Cancer B staging system were analyzed. An AFP response was defined as a decrease in AFP of more than 20% after a TACE session. The association between AFP response and treatment outcome regarding imaging response and overall survival (OS) was explored. Cox proportional hazards models were applied to identify independent risk factors for OS after TACE. ResultsOf the enrolled 376 patients with elevated serum AFP >20 ng/mL, 214 (57%) with AFP responses were identified. AFP responders had improved median survival than non-responders (20 vs. 12 months, P = 0.002). AFP response was significantly correlated with imaging response (P < 0.001). The Cox proportional hazards model revealed that AFP response was an independent factor for OS (hazard ratio, 0.59; 95% confidence interval, 0.45–0.78; P < 0.001). In stratified analyses, an AFP response achieved improved survival in patients with tumor diameters ≤5 cm, diameters >5 cm, tumor number ≤3 and without underlying cirrhosis. ConclusionsThe AFP response indicates enhanced survival after TACE in patients with intermediate-stage BCLC.

Randomized, open label, multicenter, phase II trial of transcatheter arterial chemoembolization (TACE) therapy in combination with sorafenib as compared with TACE alone in patients with hepatocellular carcinoma: TACTICS trial.

4017Background: There is no proven evidence that combination therapy of TACE with sorafenib (TS group) prolong progression-free survival (PFS) and/or overall survival (OS) compared to TACE alone (T group) in patients with unresectable HCC. Methods: In this randomized, open label, multicenter, comparative trial (NCT01217034), patients with unresectable HCC, Child-Pugh score ≤7, ECOG performance status 0-1, no vascular invasion (VI), no extrahepatic spread (EHS), size≤10 cm and number≤10 and adequate organ function were randomized 1:1 (stratification by institution, Milan criteria in or out, and number of previous TACE 0 or 1-2) to T or TS. In TS group, sorafenib 400 mg once daily was pretreated for 2-3 weeks prior to TACE followed by 800mg once daily during on-demand conventional TACE sessions until the time to unTACEable progression (TTUP), which was defined as the time to the date of a state when TACE continuation is not possible due to untreatable tumor progression, deterioration to Child-Pugh C or appe...

Novel Albumin-Bilirubin Grade-Based Risk Prediction Model for Patients with Hepatocellular Carcinoma Undergoing Chemoembolization.

Recently, albumin-bilirubin (ALBI) grade has been suggested as a better surrogate for hepatic functional reserve for patients with hepatocellular carcinoma (HCC). We developed and validated a novel prediction model to predict outcome for HCC patients who underwent transcatheter arterial chemoembolization (TACE) as a first-line therapy. From a multivariate Cox regression model for overall survival, five objective variables (ALBI grade), the Barcelona clinic liver cancer (BCLC) stage, response after the first TACE session, Alpha-fetoprotein level, and sex were chosen and the ABRAS score was developed from the derivation cohort (n=476) and scored to generate an 8-point risk prediction model. The model's prognostic performance was assessed in the randomly assigned internal validation set (n=475) and external validation set (n=243). The ALBI grade was able to stratify patient survival within the same Child-Pugh class. The time-dependent area under receiver operating characteristics curves (AUROCs) for overall survival at 1 and 3 years were 0.78 and 0.73 in the training set, 0.78 and 0.71 in the internal validation set, and 0.70 and 0.65 in the external validation set, respectively. When stratified by BCLC stage, ABRAS score at a cutoff point of more than 3, 4, and 5 for BCLC stage 0/A, B, and C could identify subset of patients with dismal prognosis. ABRAS score was useful in estimating prognosis for patients who underwent TACE as a first-line therapy. This score can be useful in planning and guiding treatment strategies with TACE, which warrants prospective validation.

Blood supply characteristics of pedunculated hepatocellular carcinoma prior to and following transcatheter arterial chemoembolization treatment: An angiographic demonstration.

Pedunculated hepatocellular carcinoma (P-HCC) is a rare type of HCC, defined as a carcinoma protruding from the liver with or without a pedicle with a low degree of liver invasion. The present study aimed to evaluate the characteristics of blood supply of P-HCC prior to and following transcatheter arterial chemoembolization (TACE) treatment. Angiographic findings prior to and following TACE treatment in 39 patients with P-HCC were analyzed retrospectively. Angiography performed at the first TACE session revealed 70 tumor-feeding arteries collectively in all patients, including 31/70 (44.0%) extrahepatic parasitic arteries in 23/39 patients (59.0%). The intrahepatic arteries served as the main blood supply to P-HCC in all patients. Extrahepatic collateral blood supplies to P-HCCs were significantly associated with larger tumor diameter (χ2=164.000, P<0.001), but not tumor location (χ2=7.358, P=0.061). Following repeated TACE treatment, all angiographies revealed a total of 131 tumor feeding arteries collectively in all patients, including intrahepatic arteries (54/131) and extrahepatic collateral arteries (78/131) in 31 patients (79.5%). Compared with angiographies performed at the initial TACE treatment, these results also demonstrated an increase in the number of extrahepatic collateral arteries, which produced 47 new blood vessels (χ2=4.278, P=0.039). P-HCC tumor lesions readily acquired a parasitic blood supply from adjacent vessels following repeated TACE. Intrahepatic arteries functioned as the main blood supply for P-HCC, whereas extrahepatic collateral arteries were complementary to P-HCC, regardless of whether the patient was pre- or post-TACE. Extrahepatic collateral supplies to P-HCCs that originated from adjacent vessels were rich, were closely associated with tumor size, and were prone to be newly established following repeated TACE.

A Case Series of Liver Abscess Formation after Transcatheter Arterial Chemoembolization for Hepatic Tumors.

Background:Liver abscess is a serious complication following transcatheter arterial chemoembolization (TACE). Much attention has been paid to this condition as it may interfere with the treatment process and result in a poor prognosis of the patient. This study aimed to analyze the causes of liver abscess, a complication, after TACE for hepatic tumors and to summarize management approaches.Methods:From June 2012 to June 2014, of 1480 consecutive patients who underwent TACE at our hospital, five patients developed liver abscess after TACE procedures for hepatic tumors. Of the five patients, each receiving conventional TACE, one underwent three sessions, two underwent two sessions, and the remaining two underwent one session of TACE. Demographic and clinical characteristics, together with management approaches and prognosis, were collected through a review of medical records.Results:These five patients were confirmed to have post-TACE liver abscess through clinical manifestations, laboratory, and imaging tests. After percutaneous drainage and anti-inflammatory treatments, the symptoms present in four patients with liver abscess significantly improved as evidenced by shrinkage or disappearance of the abscess cavity, and the patients recovered completely after sufficient drainage. The remaining patient experienced recurrent symptoms and abdominal abscess, achieved no significant improvement after treatment, and eventually died of severe infection and multiple organ failures.Conclusions:TACE must be implemented with extreme caution to avoid liver abscess. An effective management relies on an early diagnosis, prompt use of sufficient doses of appropriate antibiotics, and active implementation of abscess incision, drainage, and aspiration.

Transcatheter arterial chemoembolization of hepatocellular carcinoma in patients with celiac axis occlusion using pancreaticoduodenal arcade as a challenging alternative route

IntroductionCeliac axis occlusion is a challenging condition when catheterization of the hepatic artery is required for chemoembolization of hepatocellular carcinoma (HCC). As a result, the hepatic artery has to be catheterized through the pancreaticoduodenal arcades (PDA) and the gastroduodenal artery (GDA) from the superior mesenteric artery (SMA) which is a tortuous course with acute angles and small caliber branches. ObjectiveTo assess new techniques for facilitating catheterization of the tortuous PDA and the GDA to reach the proper hepatic artery (PHA) and tumor-feeding branches in patients with celiac axis occlusion undergoing chemoembolization of HCC. Methods and materialsThe study included eleven patients all admitted to do transcatheter arterial chemoembolization (TACE) for treatment of unresectable HCC. During angiography occlusion of the celiac axis was diagnosed and hypertrophied PDA and GDA was noted in SMA angiography. Catheterization of the PDA was performed by preshaping of the micro-guide wire into a wide curve.Catheterization of the PHA was a challenge and was achieved by reshaping of the micro-guide wire or by looping technique. TACE was done after super selective catheterization of the tumor feeding artery using a mixture of 50mg of adriamycin, 7cc of lipiodol and gelfoam. ResultsIn the eleven patients with celiac artery occlusion, DSA showed complete celiac axis occlusion in all patients. Collateral arteries supplying the liver were readily evident via PDA and GDA from SMA. Successful catheterization of the PHA was achieved in all patients. Chemoembolization was performed to all patients after super selective catheterization of the feeding artery. Follow-up triphasic CT was performed in all patients, 9 patients showed good lipiodol trapping with no residual tumor enhancement. Two patients required another session of TACE. ConclusionChemoembolization of HCC through the PDA and the GDA using micro-guide wire preshaping technique and the microcatheter looping technique in patients with celiac axis occlusion is a challenging but effective treatment for HCC.

Early treatment response to transcatheter arterial chemoembolization is associated with time to the development of extrahepatic metastasis and overall survival in intermediate-stage hepatocellular carcinoma.

Transcatheter arterial chemoembolization (TACE) is the treatment of choice for intermediate-stage hepatocellular carcinoma (HCC). The absence of an early response to TACE might indicate alternative therapeutic strategies early in the course of the disease, thus improving outcomes. Therefore, our purpose was to identify the relationship between treatment response after two sessions of TACE and the time to the development of extrahepatic metastasis and overall survival. In total, 108 treatment-naïve intermediate-stage HCC patients who received at least two consecutive sessions of TACE as the first-line treatment were analyzed. The median follow-up duration was 28.5months. Extrahepatic metastasis developed in 32 patients (29.6%). Patient age >60years (P=0.027), alpha-fetoprotein (AFP) >200ng/ml (P=0.039), and objective response after two TACE treatments (P=0.001) were the predictive factors for time to the development of metastasis. The median survival time for the patients who achieved objective response after two sessions of TACE was 45.9 and 14.4months for the patients who failed to achieve objective response (P=0.0001). Objective response after two TACE treatments (P=0.0001) and the occurrence of extrahepatic metastasis (P=0.002) were associated with overall survival. Early objective tumor response after two sessions of TACE was associated with prolonged time to metastasis and improved survival. Therefore, surveillance for metastasis should be performed more frequently when an objective response is not obtained after two sessions of TACE and in younger intermediate-stage HCC patients with high AFP levels.

Contrast-Induced Nephropathy in Patients with Hepatocellular Carcinoma Undergoing Transcatheter Arterial Chemoembolization

Purpose: The purpose of this retrospective study was to assess the incidence and the risk factors of contrast-induced nephropathy (CIN) following transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Materials and Methods: We performed a retrospective review of 186 sessions of TACE in 122 patients with HCC. We examined the incidence and factors associated with risk of CIN, defined as an increase of at least 0.5 mg/dl (44.2 μmol/l) or 25% of the baseline serum creatinine level between 48 and 72 hours after TACE. Results: CIN developed in 14 (7.5%) of the 186 sessions after TACE. A univariate analysis showed that the Child-Pugh class B or C [10/14 (71%) vs. 70/172 (41%), P = 0.046], a low albumin level (3.0 ± 0.5 vs. 3.4 ± 0.6, P = 0.018), and a low hemoglobin level (10.6 ± 2.0 vs. 11.8 ± 2.0, P = 0.035) were significantly associated with the development of CIN. Multivariate analysis revealed that the hemoglobin value was associated with CIN [odds ratio (OR) 1.6; P = 0.038]. Conclusions: CIN after TACE is closely associated with the severity of liver cirrhosis, and with low levels of albumin and hemoglobin. Effective preventive methods remain to be considered in patients with HCC and advanced LC who are undergoing TACE.