To Transarterial Chemoembolization Research Articles

Assessment of efficacy and safety of irreversible electroporation versus TACE for treatment of difficult location hepatocellular carcinoma

IntroductionRadiofrequency ablation (RFA) and microwave ablation (MWA) are widely accepted as the established treatment options for patients diagnosed with early-stage hepatocellular carcinoma (HCC) who are deemed unfit for surgical procedures. However, the effective implementation of these techniques is hindered by various challenges, primarily associated with the precise targeting of tumors within the liver. The utilization of thermal ablative methods is not recommended for hepatocellular carcinoma (HCC) that is located near intestinal loops, bile ducts, or in eccentric positions. The unmet need for non-thermal methods in the treatment of hepatocellular carcinoma (HCC) was addressed following the introduction of irreversible electroporation (IRE) as an innovative approach.Aim of the workTo assess the efficacy, safety, and outcomes of IRE in the treatment of difficult-located HCC compared to transarterial chemoembolization (TACE).MethodsThis is a prospective study that included 24 patients with HCC who presented to the National Hepatology and Tropical Medicine Research Institute (NHTMRI) during the period from January 2017 to January 2020. Ten patients underwent IRE, while 14 patients underwent TACE.ResultsSixteen patients (66.7%) were males; eight patients were females (33.3%). Their median age was 60.5 years (48–70 years). Seventeen patients (70.8%) were Child–Pugh class A, while seven patients (29.2%) were Child–Pugh class B. All the study population had a single focal lesion; the mean size of the focal lesions was 2.94 ± 0.59 cm. The most frequent difficult locations of HCC were segment V focal lesions adjacent to both the common bile duct and portal vein in eight patients (33.3%) followed by lesions adjacent to the inferior vena cava in five patients (20%) followed by the subcapsular lesions in three patients (12.5%) and lesions adjacent to the right kidney in two patients (8.3%). Complete response (CR) was higher in the IRE group (80%) compared to the TACE group (50%). Clinical decompensation occurred in six patients in the IRE group (60%) and eight patients in the TACE group (57.1%) (P value 1). Recurrence occurred in five patients (50%) treated with IRE and in seven patients (50%) treated with TACE (P value 1). Within the IRE group, two patients (20%) remained alive; on the other hand, within the TACE group six patients (42.9%) remained alive by the end of the study (P value 0.388).ConclusionOur data suggest that IRE is an effective procedure in the treatment of difficult-located HCC in terms of complete response, fewer sessions, and fewer side effects as compared to TACE.

Hepatic arterial infusion chemotherapy for hepatocellular carcinoma refractory to transarterial chemoembolization: exploring the influence of prior transarterial chemoembolization and additional transarterial chemoembolization on survival outcomes.

The selection of an efficacious treatment modality for patients with hepatocellular carcinoma (HCC) diagnosed as refractory to transarterial chemoembolization (TACE) presents numerous challenges. In addition to systemic therapies, hepatic arterial infusion chemotherapy (HAIC) may serve as an alternative option. However, it is imperative to identify patients who are appropriate candidates for HAIC to confer a survival benefit. Our study aimed to evaluate the impact of the number of TACE sessions prior to HAIC treatment and the addition of TACE during HAIC on the survival of HCC patient's refractory to TACE. This retrospective study included 82 patients with HCC refractory to TACE (mean age 60.5 years, 75 males). Survival analysis was conducted using the Kaplan-Meier method, with comparison between two groups via the log-rank test; the Cox regression model was utilized to identify factors influencing survival. The overall response rate (ORR) was observed to be 29.3%, with a disease control rate (DCR) of 56.1%. Patients receiving more than four TACE sessions prior to HAIC exhibited a significantly poorer survival prognosis compared to those receiving fewer than four TACE sessions, with a hazard ratio (HR) of 0.151 (P=0.02). The median overall survival (OS) was markedly different, being 3.4 (range, 0.5-13.6) months for the former group and 14 (range, 8.5-19.5) months for the latter (P=0.01). Furthermore, patients undergoing additional TACE while receiving HAIC treatment demonstrated improved survival outcomes compared to those who did not, with an HR of 0.491 (P=0.02); the respective OS for these groups was 14 (range, 3.6-14.4) and 6.7 (range, 2.8-11) months (P=0.02). HAIC can be a suitable alternative treatment for HCC patient's refractory to TACE. For those with a history of more than 4 TACE sessions, other alternative treatments should be considered. The addition of TACE during HAIC treatment may extend patient OS time, provided it is balanced with maintaining safe liver function.

Stereotactic Body Radiation Therapy (SBRT) Versus Transarterial Chemoembolization (TACE) for Treatment Of Hepatocellular Carcinoma: a Meta-Analysis of Propensity Matched Studies

Introduction: There are currently limited data comparing the efficacy of stereotactic body radiation therapy (SBRT) to transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC). The aim of this systematic review and meta-analysis was to report on the summary effect estimate of overall survival and local control at 1-year based on available evidence.
 Methods: A literature search was conducted in PubMed from database inception until April 2020. Articles were independently screened by two reviewers and included if they reported on a propensity-matched study design comparing SBRT to TACE for the treatment of HCC with at least 1 year follow up. Event data of overall survival and local control at 1-year were extracted. A random-effects model was applied to generate summary odds ratio and corresponding 95% confidence intervals (CI).
 Results: Four studies with 606 patients were identified and included. SBRT (73.6%) and TACE (67.0%) had similar 1-year rates of OS, with an OR of 0.87 (0.56, 1.37). SBRT (88.4%) had greater local control at 1 year compared to TACE (71.7%); OR of 0.34 (0.13, 0.86).
 Conclusion: SBRT is comparable to TACE in terms of 1-year survival for the treatment HCC and may provide an advantage in terms of local control. Future controlled trials are necessary to determine the clinical advantages and best indications for each treatment.

Value of computed tomography-based lipiodol retention pattern in the assessment of hepatocellular carcinoma complete response following conventional transarterial chemoembolization

BackgroundConventional transarterial chemoembolization (cTACE) has emerged as a major treatment modality for unresectable hepatocellular carcinoma (HCC). Efforts have recently been made to identify biomarkers of HCCs that can potentially predict the response of lesions to transarterial chemoembolization (TACE) therapy. The goal of these efforts is to simplify the decision-making process on whether a patient should choose cTACE or pursue other treatment options. Among these, computed tomography (CT) based lipiodol retention analysis has shown promise in providing valuable insights into post-TACE outcomes. This study aimed to investigate the value of CT-based lipiodol retention pattern in predicting recurrence after a state of complete response (CR) according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) guideline post-cTACE.MethodsFrom January 2022 to June 2023, a cohort of 30 patients with 40 HCCs who received a primary cTACE session were identified. The study included patients who underwent 1st cTACE session with no more than three HCCs. Ten HCC lesions were eliminated owing to different reasons (illustrated in the flow chart). Tumor response was evaluated based on mRECIST on 1st follow-up CT with a particular focus on tumors demonstrating a complete response. Patterns of lipiodol retention within these tumors were categorized as complete lipiodol retention pattern (C-Lip), covering the whole tumor, or incomplete lipiodol retention pattern (I-Lip). Recurrence was defined when reappearance of enhancement on arterial-phase images of the treated lesion with subsequent washout on portal/delayed phase images occurred corresponding to findings of restricted diffusion on follow-ups DCE-MRI.ResultsA total of 30 HCCs with a CR were classified into 21 (70%) with C-Lip and 9 (30%) with I-Lip. After a median follow-up of 6.00 ± 2.27 months (3–9 months), 8/9 (88.9%) I-Lip and 5/21 (23.8%) C-Lip showed recurrence on follow-up (DCE-MRI), (p < 0.01), with no significant difference in the time of progression (mean 5.57 ± 2.69 for C-Lip vs. 6.00 ± 2.27 months for I-Lip, with (p < 0.5).ConclusionsHCCs exhibit complete lipiodol retention alongside mRECIST CR possess a reduced susceptibility of recurrence, thereby potentially benefiting from MRI during subsequent evaluations. Conversely, the presence of incomplete lipiodol retention in conjunction with mRECIST CR is an indication of a high risk of recurrence and may require further treatment.

Radiomics features of computed tomography and magnetic resonance imaging for predicting response to transarterial chemoembolization in hepatocellular carcinoma: a meta-analysis.

To examine the methodological quality of radiomics-related studies and evaluate the ability of radiomics to predict treatment response to transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). A systematic review was performed on radiomics-related studies published until October 15, 2022, predicting the effectiveness of TACE for HCC. Methodological quality and risk of bias were assessed using the Radiomics Quality Score (RQS) and Quality Assessment of Diagnostic Accuracy Studies-2 tools, respectively. Pooled sensitivity, pooled specificity, and area under the curve (AUC) were determined to evaluate the utility of radiomics in predicting the response to TACE for HCC. In this systematic review, ten studies were eligible, and six of these studies were used in our meta-analysis. The RQS ranged from 7-21 (maximum possible score: 36). The pooled sensitivity and specificity were 0.89 (95% confidence interval (CI) = 0.79-0.95) and 0.82 (95% CI = 0.64-0.92), respectively. The overall AUC was 0.93 (95% CI = 0.90-0.95). Radiomics-related studies evaluating the efficacy of TACE in patients with HCC revealed promising results. However, prospective and multicenter trials are warranted to make radiomics more feasible and acceptable.

Interventional Treatment Strategies in Intrahepatic Cholangiocarcinoma and Perspectives for Combined Hepatocellular-Cholangiocarcinoma.

cHCC-CCA is an uncommon type of liver cancer that exhibits clinical and pathological characteristics of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), which are the two main forms of primary liver cancer. The similarity to HCC and CCA makes therapeutical strategies challenging. The poor prognosis of CCA in general, as well as for cHCC-CCA, is mainly attributable to the fact that diagnosis is often at an advanced stage of disease. During the last decade, locoregional therapies usually performed by interventional radiologists and its established role in HCC treatment have gained an increasing role in CCA treatment as well. These comprise a wide range of options from tumor ablation procedures such as radiofrequency ablation (RFA), microwave ablation (MWA), computed tomography high-dose rate brachytherapy (CT-HDRBT), and cryoablation to transarterial chemoembolization (TACE), including the option of intra-arterial administration of radioactive spheres (transarterial radioembolization-TARE), and much attention has focused on the potential of individual concepts in recent years. The purpose of this review is to provide an overview of current radiologic interventions for CCA (excluding options for eCCA), to review and appraise the existing literature on the topic, and to provide an outlook on whether such interventions may have a role as treatment for cHCC-CCA in the future.

Efficacy and safety of hepatic artery infusion chemotherapy combined with tyrosine kinase inhibitors plus programmed death-1 inhibitors for hepatocellular carcinoma refractory to transarterial chemoembolization.

The subsequent therapy for hepatocellular carcinoma (HCC) patients with refractory to transarterial chemoembolization (TACE) is still controversial. This study was performed to evaluate the efficacy and safety of combination therapy comprising hepatic artery infusion chemotherapy (HAIC), lenvatinib, and programmed death-1 inhibitors relative to HAIC combined with lenvatinib. In this single-center retrospective study, we analyzed data from HCC patients with refractory to TACE from June 2017 to July 2022. Primary study outcomes were overall survival (OS) and progression-free survival (PFS), while the secondary outcomes were the objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events. We enrolled 149 patients finally, including 75 patients who received HAIC combined with lenvatinib plus PD-1 inhibitors therapy (HAIC+L+P group) and 74 patients who received HAIC combined with lenvatinib therapy (HAIC+L group). The median OS in the HAIC+L+P group (16.0; 95% CI: 13.6~18.3 months) was significantly higher compared to the HAIC+L group (9.0; 95% CI: 6.5~11.4 months) (p = 0.002), while the median PFS in the HAIC+L+P group (11.0; 95% CI: 8.6~13.3 months) was significantly higher compared to the HAIC+L group (6.0; 95% CI: 5.0~6.9 months) (p < 0.001). Significant between-group differences in DCR (p = 0.027) were found. Additionally, 48 pairs of patients were matched after propensity matching analysis. The survival prognosis between two groups before propensity matching is similar to that after propensity matching. Moreover, the percentage of patients with hypertension in the HAIC+L+P group was significantly higher compared to the HAIC+L group (28.00% vs. 13.51%; p = 0.029). A combination therapy of HAIC, lenvatinib, and programmed death-1 inhibitors significantly improved oncologic response and prolonged survival duration, showing a better survival prognosis for HCC patients with refractory toTACE.

CXCL1 and CXCL6 Are Potential Predictors for HCC Response to TACE.

Distinct immune patterns of hepatocellular carcinoma (HCC) may have prognostic implications in the response to transarterial chemoembolization (TACE). Thus, we aimed to exploratively analyze tumor tissue of HCC patients who do or do not respond to TACE, and to identify novel prognostic biomarkers predictive of response to TACE. We retrospectively included 15 HCC patients who had three consecutive TACE between January 2019 and November 2019. Eight patients had a response while seven patients had no response to TACE. All patients had measurable disease according to mRECIST. Corresponding tumor tissue samples were processed for differential expression profiling using NanoString nCounter® PanCancer immune profiling panel. Immune-related pathways were broadly upregulated in TACE responders. The top differentially regulated genes were the upregulated CXCL1 (log2fc 4.98, Benjamini-Hochberg (BH)-p < 0.001), CXCL6 (log2fc 4.43, BH-p = 0.016) and the downregulated MME (log2fc -4.33, BH-p 0.001). CD8/T-regs was highly increased in responders, whereas the relative number of T-regs to tumor-infiltrating lymphocytes (TIL) was highly decreased. We preliminary identified CXCL1 and CXCL6 as candidate genes that might have the potential to serve as therapeutically relevant biomarkers in HCC patients. This might pave the way to improve patient selection for TACE in HCC patients beyond expert consensus.

Contrast-Enhanced CT Imaging Features Combined with Clinical Factors to Predict the Efficacy and Prognosis for Transarterial Chemoembolization of Hepatocellular Carcinoma

Accurate prediction of treatment response to transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) is critical for precision treatment. This study aimed to develop a comprehensive model (DLRC) that incorporates contrast-enhanced computed tomography (CECT) images and clinical factors to predict the response to TACE in patients with HCC. A total of 399 patients with intermediate-stage HCC were included in this retrospective study. Deep learning and radiomic signatures were established based on arterial phase CECT images, Correlation analysis and the least absolute shrinkage and selection (LASSO) regression analysis were applied for features selection. The DLRC model incorporating deep learning radiomic signatures and clinical factors was developed using multivariate logistic regression. The area under the receiver operating characteristic curve (AUC), calibration curve and decision curve analysis (DCA) were used to evaluate the performance of the models. Kaplan-Meier survival curves based on the DLRC were plotted to assess overall survival in the follow-up cohort (n=261). The DLRC model was developed using 19 quantitative radiomic features, 10 deep learning features, and 3 clinical factors. The AUC of the DLRC model was 0.937 (95% confidence interval [CI], 0.912-0.962) and 0.909 (95% CI, 0.850-0.968) in the training and validation cohorts, respectively, outperforming models established with two signatures or a single signature (p < 0.05). Stratified analysis showed that the DLRC was not statistically different between subgroups (p > 0.05), and the DCA confirmed the greater net clinical benefit. In addition, multivariable cox regression revealed that DLRC model outputs were independent risk factors for the overall survival (hazard ratios: 1.20, 95% CI: 1.03-1.40; p=0.019). The DLRC model exhibited a remarkable accuracy in predicting response to TACE, and it can be utilized as a potent tool for precision treatment.

A novel transcription factor-based signature to predict prognosis and therapeutic response of hepatocellular carcinoma.

Background: Hepatocellular carcinoma (HCC) is one of the most common aggressive malignancies with increasing incidence worldwide. The oncogenic roles of transcription factors (TFs) were increasingly recognized in various cancers. This study aimed to develop a predicting signature based on TFs for the prognosis and treatment of HCC. Methods: Differentially expressed TFs were screened from data in the TCGA-LIHC and ICGC-LIRI-JP cohorts. Univariate and multivariate Cox regression analyses were applied to establish a TF-based prognostic signature. The receiver operating characteristic (ROC) curve was used to assess the predictive efficacy of the signature. Subsequently, correlations of the risk model with clinical features and treatment response in HCC were also analyzed. The TF target genes underwent Gene Ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses, followed by protein-protein-interaction (PPI) analysis. Results: A total of 25 differentially expressed TFs were screened, 16 of which were related to the prognosis of HCC in the TCGA-LIHC cohort. A 2-TF risk signature, comprising high mobility group AT-hook protein 1 (HMGA1) and MAF BZIP transcription factor G (MAFG), was constructed and validated to negatively related to the overall survival (OS) of HCC. The ROC curve showed good predictive efficiencies of the risk score regarding 1-year, 2-year and 3-year OS (mostly AUC >0.60). Additionally, the risk score independently predicted OS for HCC patients both in the training cohort of TCGA-LIHC dataset (HR = 2.498, p = 0.007) and in the testing cohort of ICGC-LIRI-JP dataset (HR = 5.411, p < 0.001). The risk score was also positively correlated to progressive characteristics regarding tumor grade, TNM stage and tumor invasion. Patients with a high-risk score were more resistant to transarterial chemoembolization (TACE) treatment and agents of lapatinib and erlotinib, but sensitive to chemotherapeutics. Further enrichment and PPI analyses demonstrated that the 2-TF signature distinguished tumors into 2 clusters with proliferative and metabolic features, with the hub genes belonging to the former cluster. Conclusion: Our study identified a 2-TF prognostic signature that indicated tumor heterogeneity with different clinical features and treatment preference, which help optimal therapeutic strategy and improved survival for HCC patients.

Retrograde venous coil embolization prior to transarterial chemoembolization in hepatocellular carcinoma with arterio-hepatic venous shunts.

PURPOSE This study explored the clinical efficacy of transcatheter retrograde shunt occlusion with coils to prevent pulmonary oil or particle embolization prior to transarterial chemoembolization (TACE) in patients with artero-hepatic venous shunts (AHVS) secondary to hepatocellular carcinoma (HCC). METHODS From July 2017 to January 2021, 6 patients with advanced, unresectable HCC were found to have an AHVS by hepatic arteriography at the time of attempted TACE. The AHVS was embolized ret rogradely with metal coils through a transfemoral or transjugular venous approach. After venous embolization and confirmation of the absence of the AHVS, TACE was performed using an emul sion of iodized oil and doxorubicin or drug-eluting beads. Follow-up computed tomography (CT) was performed within 1 month after the first TACE to evaluate the results and complications. RESULTS Hepatic angiography after venous embolization showed that AHVS had utterly disappeared in all patients during the operation. The immediate technical success of the retrograde venous embo lization was 100%. The AHVS had disappeared entirely during the follow-up period through triple-phase enhancement CT scanning. According to the modified response evaluation criteria in solid tumors, TACE in all 6 patients had a disease control response rate of 100% (6/6) with complete response in 2 patients and partial response in 4 patients. One patient died during the 6-month follow-up, and the other 5 were still alive. No complications related to pulmonary embolism occurred. CONCLUSION Retrograde venous coil embolization of AHVS via the draining hepatic vein appears to be a safe, feasible, and effective treatment to allow TACE treatment without pulmonary embolic events. This approach appears to provide better tumor control and effectively decreases the occurrence of pulmonary embolism.

Post-Intervention Plasma IL-10 Level Predicts Early Tumor Response in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization

Background: Cytokines play an important role in tumor progression, but studies have shown mixed results regarding the role of cytokines in predicting the early response to transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC). Objectives: This study aimed to explore the correlation between plasma levels of cytokines and early tumor response in HCC patients undergoing TACE. Methods: Thirty HCC patients enrolled in this study from the department of liver disease of a general hospital from June 2020 to January 2021. Plasma samples were sampled at baseline and 7 days after TACE for cytokine detection by cytometric bead array (CBA). At 4 - 6 weeks after TACE, the objective response of HCC patients was confirmed according to response evaluation criteria in solid tumors (RECIST). Potential factors such as various cytokines and some clinical parameters were analyzed by univariate and multivariate analysis. The predictive effects of different factors in HCC patients undergoing TACE were analyzed by the receiver operating characteristic (ROC) curve. Results: Plasma levels of post-TACE interleukin-10 (IL-10) were statistically significantly higher than baseline IL-10 levels. The level of plasma IL-10 after TACE was an independent risk factor for early tumor response. The patients with low plasma IL-10 levels after TACE had a favorable prognosis. Receiver operating characteristic curve analysis showed that post-TACE IL-10 had a high predictive value (area under the curve = 0.769, 95% confidence interval (CI): 0.598 - 0.939). A high level of plasma IL-10 after TACE was correlated with alpha-fetoprotein (AFP) level (P = 0.037) and post-TACE alanine aminotransferase (ALT) (r = 0.368, P = 0.045). Post-TACE plasma IL-10 did not correlate with age or tumor metastasis. Conclusions: Our findings demonstrated that post-intervention plasma IL-10 levels could predict short-term outcomes independently after TACE. These findings were helpful in identifying the patients who might benefit from TACE.

Development and validation of a pyradiomics signature to predict initial treatment response and prognosis during transarterial chemoembolization in hepatocellular carcinoma.

We aimed to develop and validate a pyradiomics model for preoperative prediction of initial treatment response to transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). To this end, computed tomography (CT) images were acquired from multi-centers. Numerous pyradiomics features were extracted and machine learning approach was used to build a model for predicting initial response of TACE treatment. The predictive accuracy, overall survival (OS), and progression-free survival (PFS) were analyzed. Gene Set Enrichment Analysis (GSEA) was further used to explore signaling pathways in The Cancer Genome Atlas (TCGA)-HCC cohort. Overall, 24 of the 1,209 pyradiomic features were selected using the least absolute shrinkage and selection operator (LASSO) algorithm. The pyradiomics signature showed high predictive accuracy across the discovery set (AUC: 0.917, 95% confidence interval [CI]: 86.93-96.39), validation set 1 (AUC: 0.902, 95% CI: 84.81-95.59), and validation set 2 (AUC: 0.911; 95% CI: 83.26-98.98). Based on the classification of pyradiomics model, we found that a group with high values base on pyramidomics score showed good PFS and OS (both P<0.001) and was negatively correlated with glycolysis pathway. The proposed pyradiomics signature could accurately predict initial treatment response and prognosis, which may be helpful for clinicians to better screen patients who are likely to benefit from TACE.

Dickkopf-Related Protein 1 as Response Marker for Transarterial Chemoembolization of Hepatocellular Carcinomas.

Simple SummaryThe response of hepatocellular carcinomas (HCC) to transarterial chemoembolization (TACE) is variable. In view of the dynamic development of treatment options for HCCs, an early selection of the most effective therapy for maximizing individual treatment success has a high medical need. We show that serum levels of circulating Dickkopf-related protein 1 (DKK-1) are associated with a 12-week response to subsequent TACE in European patients. DKK-1 levels also allowed for identification of responders in patients with normal levels of alpha fetoprotein. Our findings are a step toward developing DKK-1 as a novel HCC response marker and an impulse to investigate the mechanisms underlying the treatment response of HCCs.Background and Aims: In the treatment of hepatocellular carcinoma (HCC), response prediction to transarterial chemoembolization (TACE) based on serum biomarkers is not established. We have studied the association of circulating Dickkopf-related protein 1 (DKK-1) with baseline characteristics and response to TACE in European HCC patients. Methods: Patients with HCC treated with TACE from 2010 to 2018 at a tertiary referral hospital were retrospectively enrolled. Levels of DKK-1 were measured in serum samples collected before TACE. Response was assessed according to mRECIST criteria at week 12 after TACE. Results: Ninety-seven patients were enrolled, including seventy-nine responders and eighteen refractory. Before TACE, median DKK-1 serum levels were 922 [range, 199–4514] pg/mL. DKK-1 levels were lower in patients with liver cirrhosis (p = 0.002) and showed a strong correlation with total radiologic tumor size (r = 0.593; p < 0.001) and with Barcelona Clinic Liver Cancer stages (p = 0.032). Median DKK-1 levels were significantly higher in refractory patients as compared to responders (1471 pg/mL [range, 546–2492 pg/mL] versus 837 pg/mL [range, 199–4515 pg/mL]; p < 0.001), and DKK-1 could better identify responders than AFP (AUC = 0.798 vs. AUC = 0.679; p < 0.001). A DKK-1 cutoff of ≤1150 pg/mL was defined to identify responders to TACE with a sensitivity of 78% and specificity of 77%. DKK-1 levels were suitable to determine response to TACE in patients with low AFP serum levels (AFP levels < 20 ng/mL; AUC = 0.843; 95% CI [0.721–0.965]; p = 0.003). Conclusion: DKK-1 levels in serum are strongly associated tumor size and with response to TACE in European HCC patients, including those patients with low AFP levels.

TACE versus TARE for patients with hepatocellular carcinoma: Overall and individual patient level meta analysis.

Transarterial radioembolization (TARE) is increasingly used as an alternative to transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC). We aimed to perform an overall and individual patient data (IPD) meta-analysis of studies comparing TACE and TARE. We performed a systematic literature search using pre-specified keywords with the aid of an informationist for articles from inception to 3/2020. The primary endpoint was overall survival (OS), and the secondary endpoint was time to progression (TTP). Seventeen studies met inclusion criteria with 2465 unique patients, with one randomized trial, 4 prospective studies and 12 retrospective studies. Barcelona Clinic Liver Cancer (BCLC) stage B (42.8%) was the most common stage followed by BCLC A (30.3%) and BCLC C (29.0%). There was no difference in OS between the two modalities (-0.55 months, 95% CI -1.95 to 3.05). In three studies with available TTP data, TARE resulted in a longer TTP than TACE (mean TTP 17.5 vs. 9.8 months; mean TTP difference 4.8months, 95% CI 1.3-8.3months). IPD-level meta-analysis of 311 patients from three studies showed no difference in overall OS between the two modalities including among subgroups stratified by tumor stage and liver function. Limitations of the current literature include inconsistent length of follow-up, inconsistency in response criteria, and safety reporting. Current data suggest TARE provides significantly longer TTP than TACE, although the two treatments do not significantly differ in terms of OS. Given limitations of the current data, there is rationale for prospective studies comparing these modalities.

A systematic literature review of the economic evidence for transarterial radioembolization for the treatment of hepatocellular carcinoma.

e16159 Background: Evidence synthesis can be used to demonstrate the economic value of medical technologies. Transarterial radioembolization (TARE) is a clinically effective therapy for hepatocellular carcinoma (HCC); however, a synthesis of the comparative economic outcomes is lacking. This study systematically reviewed and summarized the available economic evaluations of TARE for the treatment of HCC. Methods: A systematic review of economic evaluations of TARE for HCC treatment following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. English and Spanish publications were identified from PubMed, Embase, Cochrane, MEDES, health technology assessment agencies, and scientific congress databases published through May 2021. Results: Among 423 records screened, 20 economic evaluations (two cost-effectiveness analyses (CEAs), eight cost-utility analyses (CUAs), one cost-minimization analysis, six cost analyses, and three budget impact analyses) met the pre-defined criteria for inclusion. Included studies were evaluated from a payer perspective (n = 20) and included both payer and societal perspectives (n = 2). Thirteen studies were published from a European perspective, six from the United States, and one from the Canadian perspective. Included studies evaluated early (n = 4) vs. intermediate and advanced HCC (n = 15). TheraSphere and Sir-Spheres were the most evaluated TARE therapies compared to transarterial chemoembolization (TACE) (n = 12) alone or TACE/sorafenib agents (n = 10). The time horizon in the included studies varied: TARE vs. sorafenib (5-years and lifetime) and TARE vs. TACE (5-years). Variability in health outcomes was observed with greater health benefits reported for TARE vs. TACE for intermediate (n = 1) and advanced-stage patients (n = 2) and TARE vs. sorafenib for intermediate (n = 1) and advanced-stage patients (n = 6). All CEAs compared the costs and survival benefits of TARE vs. TACE/Transarterial embolization (TAE)/sorafenib/tyrosine-kinase inhibitor. Of the 20 studies, TARE was associated with lower treatment costs in ten studies. From the payer perspective, TARE costs varied widely in the Barcelona Clinic Liver Cancer (BCLC) staging system and ranged from $1,770 (BCLC-A) to $66,800 (BCLC-C). The life-years gained (LYG) ranged from 1.1 years (TARE vs. sorafenib/lenvatinib) to 3.1 years (TARE vs. TACE/TAE/drug-eluting bead-TACE). The incremental cost-utility ratio (ICUR) for TARE vs. sorafenib ranged from $38,352/QALY to $71,386 (dominant) and one CUA of TARE vs. TACE and showed an ICUR of $22,181/QALY. Conclusions: Economic evaluations of TARE for HCC treatment are heterogeneous. Overall, TARE is a cost-effective short- and long-term treatment for HCC, driven by increased LYG compared to other HCC therapies.

Abstract No. 556 Cost-effectiveness of radioembolization with Y-90 glass microspheres versus transarterial chemotherapies in the treatment of intermediate stage hepatocellular carcinoma: a U.S. hospital perspective

Transarterial radioembolization with Y-90 glass microspheres (“Y-90”) is a safe and effective alternative to transarterial chemoembolization (TACE) in patients with intermediate stage hepatocellular carcinoma (HCC). A previous economic evaluation from the UK National Health Service perspective found Y-90 to be cost-effective compared with TACE and transarterial bland embolization (TAE) in a population of unresectable HCC patients. This economic evaluation assessed the cost-effectiveness of Y-90 across the same patient population in the U.S.

Prediction of hepatocellular carcinoma response to transarterial chemoembolization with intravoxel incoherent motion diffusion-weighted imaging

BackgroundThere are several therapeutic options for hepatocellular carcinoma (HCC). As predicting the treatment response is critical in clinical decision making, we aimed to evaluate the quantitative intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) parameters as potential predictors of treatment response of HCC lesions to transarterial chemoembolization (TACE).ResultsTwelve patients (eight males; mean age, 56.12 ± 7.88) with 26 confirmed HCC lesions were recruited in the study. Thirteen lesions (50%) responded to TACE, and the remaining lesions were categorized as nonresponder. Age > 60 year (p value: 0.018), D (p value: 0.005), D* (p value: 0.005), and f (p value: 0.004) values were significantly different in response and nonresponse group lesions. Logistic multivariate analysis showed that f value (OR: 0.847 (95% CI 0.732–0.98), p value = 0.025) could independently predict tumor response to TACE. The ROC curve analysis showed f value could predict the HCC response to TACE with sensitivity and specificity of 76.9% and 76.9%, respectively.ConclusionsIVIM-DWI parameters, especially the f value, might be useful for predicting the response of the intermediate-stage HCC to TACE.

Efficacy of local‐regional treatment plus sorafenib in intermediate‐stage hepatocellular carcinoma patients refractory to transarterial chemoembolization

AbstractSorafenib treatment is suggested for patients with intermediate‐stage hepatocellular carcinoma (HCC) refractory to transarterial chemoembolization (TACE). This study aimed to study if combining local‐regional treatment with sorafenib adds benefit to patients who had tumor progression after three sessions of TACE within 12 months. We retrospectively analyzed the treatment outcomes of sorafenib alone and combined treatment of sorafenib and local‐regional therapies in intermediate‐stage HCC patients after using inverse probability of treatment weighting (IPTW). Forty‐nine patients were enrolled; 28 patients were treated with sorafenib alone, whereas 21 patients received TACE or radiofrequency ablation (RFA) in addition to sorafenib. After IPTW, the two groups were well‐balanced for most baseline characteristics. The overall response rate (ORR) and disease control rate (DCR) were significantly higher in the sorafenib‐combination group than the sorafenib‐alone group (ORR: 41.3% vs 10.0%, P = .001; DCR: 44.6% vs 22.1%). The PFS was also significantly longer in the patients of the sorafenib‐combination group than the alone group (median 5.3 vs 3.0 months, HR, 0.55; 95% CI, 0.35‐0.88). The risk of extrahepatic metastases was significantly lower in the sorafenib‐combination group (HR, 0.04; 95% CI, 0.01‐0.50). The incidence of adverse events was comparable between sorafenib‐combination and sorafenib‐alone groups. Loco‐regional therapy may be still able to exert additional survival benefit to patients taking sorafenib for TACE‐refractory intermediate‐stage HCC showing a better PFS and lower risk of extrahepatic metastases without causing significant liver dysfunction. Further investigations to identify patients who will be more likely to benefit from the combination of sorafenib with local‐regional therapy are needed.

Can Posttransarterial Chemoembolization Volumetric Oil Deposition on Computed Tomography Predict Treatment Response on Magnetic Resonance Imaging in Leiomyosarcoma Metastases to the Liver?

To predict early tumor response to transarterial chemoembolization (TACE) based on volumetric oil deposition on posttreatment computed tomography (CT) in patients with leiomyosarcoma liver metastases. This retrospective lesion-by-lesion based study included 32 lesions. The volumetric percent enhancing tumor on pre-TACE and 1-month post-TACE venous phase magnetic resonance imaging (MRI), and the percent oil deposition on CT 1 day after TACE were calculated. The predicted post-TACE enhanced percentage was computed by subtracting percent oil deposition from baseline percent enhanced. Mean percentage of viable tumor on pre-TACE MRI was 90.6% ± 9.3%. Mean oil deposition was calculated as 51.4% ± 26.2%. Mean percentage of measured residual tumor enhancement 1 month after TACE was 58.3% ± 27%, which correlates with predicted enhancement percentage of 43.9% ± 25.1% (r = 0.72, P < 0.001). A threshold of 35.5% for enhancement reduction was determined to predict tumor response with an accuracy of 78.1%. Volumetric oil deposition on CT can predict residual enhancement on post-TACE MRI.