Transcatheter Arterial Chemoembolization Group Research Articles

A Meta-analysis of transcatheter arterial chemoembolization comparing stereotactic body radiation the-rapy in patients for primary hepatic carcinoma

Objective To compare the clinical efficacy and the adverse reaction of transcatheter arterial chemoembolization (TACE) alone and combined with stereotactic body radiation therapy (SBRT) in patients with primary hepatic carcinoma by a Meta-analysis. Methods PubMed, Cochrane Library, EMBase, Ovid, MEDLIN, CNKI, CBMdisc, VIP and Wanfang were searched to identify the controlled clinical trials of TACE and SBRT for primary hepatic carcinoma. The obtained data were analyzed using Review Manager version 5.2 provided by Cochrane Collaboration. To analysis the short-term effect of TACE alone or combined with SBRT, the rate of local tumor control and the difference of one, two, three and five-year survival rate. Results A total of 1 143 patients from 10 controlled clinical trials were involved according to the inclusion criteria. The Meta-analysis showed that TACE and SBRT group significantly increased the short-term effective rate, the rate of local tumor control, l-, 2-, 3-and 5-year overall survival rates(RR=1.43, 95%CI: 1.32-1.56, P<0.000 01; RR=2.09, 95%CI: 1.63-2.69, P<0.000 01; RR=1.31, 95%CI: 1.21-1.42, P<0.000 01; RR=1.46, 95%CI: 1.23-1.72, P<0.000 01; RR=1.76, 95%CI: 1.14-2.71, P=0.01; RR=2.29, 95%CI: 1.22-4.32, P=0.01). There was no statistically significant difference between the two groups on adverse events such as leucopenia(RR=0.97, P=0.61), thrombocytopenia(RR=0.99, P=0.85), hemoglobin decrease(RR=0.95, P=0.63), nausea and vomiting(RR=1.00, P=0.98), liver function damage(RR=0.98, P=0.87). Conclusion Compared with TACE, TACE combined with SBRT can increase the short-term effective rate, the rate of local tumor control, the 1-, 2-, 3-and 5-year overall survival time of the patients, and does not increase the incidence of adverse reaction. However high-quality trials with large sample sizes are still needed to verify the long-term efficacy and safety. Key words: Liver neoplasms; Meta-analysis; Transcatheter arterial chemoembolization; Stereotactic body radiation therapy

Transcatheter arterial chemoembolization combined with interferon-α is safe and effective for patients with hepatocellular carcinoma after curative resection.

Intrahepatic recurrence is the major cause of death among patients with hepatitis B virus (HBV)- related hepatocellular carcinoma (HCC) after curative surgical resection. Several approaches have been reported to decrease the recurrence rate. The objective of our study was to compare the clinical effects of transcatheter arterial chemoembolization (TACE) combined with interferon-alpha (IFN-α) therapy on recurrence after hepatic resection in patients with HBV-related HCC with that of TACE chemotherapy alone. We retrospectively analyzed the data from 228 patients who were diagnosed with HBV-related HCC and underwent curative resection between January 2001 to December 2008. The patients were divided into TACE (n = 126) and TACE-IFN-α (n = 102) groups for postoperative chemotherapy. The TACE regimen consisted of 5-fluorouracil (5-FU), cisplatin (DDP) , and the emulsion mixed with mitomycin C (MMC) and lipiodol. The recurrence rates, disease-free survival (DFS), overall survival (OS), and risk of recurrence were evaluated. The clinicopathological parameters and adverse effects were similar between the 2 groups (P > 0.05). The median OS for the TACE- IFN-α group (36.3 months) was significantly longer than that of the TACE group (24.5 months, P < 0.05). The 3-and 5-year OS for the TACE-IFN-α group were significantly longer than those of the TACE group (P < 0.05) and the recurrence rate was significantly lower (P < 0.05). The TACE and IFN-α combination therapy, active hepatitis HBV infection, the number of tumor nodules, microvascular invasion, liver cirrhosis, and the BCLC stage were independent predictors of OS and DFS. The use of the TACE and IFN-α combination chemotherapy after curative hepatic resection safely and effectively improves OS and decreases recurrence in patients with HBV-related HCC who are at high risk. Our findings can serve as a guide for the selection of postoperative adjuvant chemotherapy for patients with HBV-related HCC who are at high risk of recurrence.

Assessment of the feasibility of TACE combined with intratumoral injection of cisplatin in hepatocellular carcinoma.

The feasibility of transcatheter arterial chemo-embolization (TACE) combined with intratumoral injection of cisplatin as treatment for hepatocellular carcinoma. 30 cases receiving TACE were denoted the TACE group, another 30 cases receiving TACE combined with an intratumoral multi-point injection of cisplatin were denoted the TACE/cisplatin group. Cases with partial remission/complete remission (PR/CR) were analyzed using 2 tests; alpha fetoprotein (AFP), aspartate amino transferase (AST), total bilirubin (TBIL), erythrocyte, and platelet levels were detected and the differences between two groups were analyzed using the Student’s t-test; cases with complications, including intrahepatic metastasis (IM), upper gastrointestinal bleeding (UGB), and liver failure were also counted. The correlation of clinical parameters with PR/CR was analyzed using multifactorial correlation analysis. Cases with PR/CR in the TACE/cisplatin group were significantly more than in TACE group, accompanied by significant declination in FAP. There were no significant differences of AST, ALT, TBIL, blood urea nitrogen (BUN), white blood cells (WBC), red blood cells (RBC), and platelets (PLT) between two groups; 3 cases with IM, one case with UGB and one case with LF were found in the TACE group, but only 1 case with IM was found in the TACE/cisplatin group. In addition, tumor stage was correlated with PR/CR. We concluded that TACE combined with intratumoral injection of cisplatin was more effective than TACE, and with fewer complications and side effects.

Meta-analysis on radiofrequency ablation in combination with transarterial chemoembolization for the treatment of hepatocellular carcinoma.

To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) and TACE alone for hepatocellular carcinoma (HCC), Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Datebases were searched for the randomized controlled trials (RCTs) and retrospective cohort studies from the establishment of the databases to January 2014. The bibliographies of the included studies were searched, too. After study selection, assessment, data collection and analysis were undertaken, we performed this meta-analysis by using the RevMan5.2 software. Seventeen studies involving 1116 patients met the inclusion criteria with 530 treated with RFA-plus-TACE and 586 with TACE alone. The results of meta-analysis showed that the combination of TACE and RFA was obviously associated with higher 1-, 2-, and 3-year overall survival rates (OR1-year=3.98, 95% CI 2.87-5.51, P<0.00001; OR2-year=3.03, 95% CI 2.10-4.38, P<0.00001; OR3-year=7.02, 95% CI 4.14-11.92, P<0.00001) than TACE alone. The tumor complete necrosis rate in patients treated with TACE and RFA was higher than that of TACE alone (OR=13.86, 95% CI 8.04-23.89, P<0.00001). And there was a significant difference in local recurrence rate between two different kinds of treatment (OR=0.24, 95%CI 0.14-0.44, P<0.00001). Additionally, combination of TACE and RFA was associated with higher complete tumor necrosis rates than TACE mono-therapy in the treatment of HCC. However, RFA plus TACE was found to be associated with a lower local recurrence rate than TACE monotherapy. TACE-plus-RFA treatment was associated with a higher response rate (RR) than the TACE-alone treatment (OR=3.90, 95% CI=2.37-6.42, P<0.00001). TACE-plus-RFA treatment did not differ from the TACE-alone treatment in terms of stable disease (SD) rate (OR=0.38, 95% CI=0.11-1.26, P=0.11). Meta-analyses showed that the combination of RFA and TACE was associated with a significantly lower progressive disease (PD) rate (OR=0.15, 95% CI=0.05-0.43, P=0.0005). The rate of AFP reducing or returning to normal in serum in RFA plus TACE group was obviously lower than TACE alone group (OR=4.62, 95% CI 2.56-8.34, P<0.00001). The effect of TACE plus RFA for HCC is better than TACE mono-therapy. The combined therapy can elevate the patients' overall survival rate, tumor necrosis rate and the rate of AFP reducing or returning to normal in serum and decrease local recurrence rate, PD rate compared with TACE alone.

Therapeutic value of transcatheter arterial chemoembolization combined with portal vein embolization for primary hepatocellular carcinoma with portal vein tumor thrombus: a pilot study.

To compare clinical outcome and safety of transcatheter arterial chemoembolization (TACE) + portal vein embolization (PVE) with TACE alone in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT). We retrospectively collected patients of HCC with PVTT treated with TACE (5-FU, oxaliplatin and mitomycin) or TACE + PVE (doxorubicin) between October 2000 and July 2008. Outcomes evaluated include overall survival, response to treatment and side effects. One hundred and sixteen patients were assessed. The median follow-up of TACE group and TACE + PVE group was 83 and 85 months, respectively. The tumor response rates were respectively 48/64 and 49/52. The 1-, 3- and 5-year overall survival rates for the TACE and TACE + PVE groups were 39/64, 16/64, 0/64 and 42/52, 19/52, 6/52 respectively (P = 0.015, 0.046 and 0.002, respectively). Three factors were shown as the risk factors which affect the survival of patients: treated by TACE + PVE or TACE; type of PVTT; and absence of cirrhosis. TACE + PVE may be better than TACE alone to treat primary HCC with PVTT.

Application of transcatheter arterial chemoembolization combined with selective portal vein embolization in two-stage hepatectomy of hepatocellular carcinoma

Objective To explore the application of transcatheter arterial chemoembolization （TACE） combined with selective portal vein embolization （SPVE ） in two-stage hepatectomy of hepatocellular carcinoma （HCC）.Methods From September 2010 to September 2013,a total of 107 patients with HCC in the right liver lobe who were not suitable for one stage hepatectomy received TACE or TACE combined with SPVE treatment were enrolled.Among them,55 received TACE therapy and 52 accepted TACE combined with SPVE treatment.The technique success rate,complication,adverse reactions,the volume change of each liver lobe and the rate of hepatectomy of HCC were observed.Chi-square test was used for numerical data comparison and Student′s t test for measurement data.Results TACE or TACE combined with SPVE therapy was successfully applied in all the 107 patients,the technique success rate was 100%.During treatment period,no complications such as ectopic embolization, liver function failure,puncture tract bleeding,gastrointestinal bleeding,bile leakage and hepatic abscess were observed.After treatment,the adverse reactions included liver function impairment,pain in hepatic region,fever,nausea and vomiting.Four weeks after the treatment,the volumes of tumor and right liver lobe decreased to certain degree in patients with HCC of both TACE group and TACE combined with SPVE group.The volume of left liver lobe in TACE group had no obvious change,while remarkably increased in TACE combined with SPVE group.The pre-treatment residual liver volume （RLV）of TACE group and TACE combined with SPVE group was （404.0 ± 46.3 ）cm^3 and （393.9 ± 65 .7 ）cm^3 , respectively,and the difference was not statistically significant （t=0.927,P =0.356）.Four weeks after the treatment,RLV was （415.4 ±45.7 ）cm^3 and （567.3 ±88.7 ）cm^3 ,respectively,and the difference was statistically significant （t= -11 .219,P 〈0.05）.Patients were followed up for three to six months,the rates of hepatectomy were 38.2%（21/55）and 86.5 %（45/52）in TACE group and TACE combined with SPVE group,and the difference was statistically significant （χ^2 =26.440,P 〈0.01 ）.Conclusion For patients with HCC not suitable for one stage hepatectomy,the treatment of TACE combined with SPVE before operation could effectively control the growth of the tumor,decrease the volume of tumor,increase RLV,and then increase the rate of two-stage hepatectomy. Key words: Liver neoplasms; Interventional; Embolization; Portal vein; Two-stage hepatectomy

Combination of percutaneous radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma: observation of clinical effects.

To observe the clinical effect of radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) for advanced hepatocellular carcinoma (HCC). A total of 92 cases of advanced primary liver cancer underwent TACE and RFA treatment from June 2005 to 2011 at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College. A total of 88 cases with complete clinical treatment and follow-up data were divided into two groups: 43 patients treated with TACE (TACE group) and 45 patients that received TACE combined with RFA treatment (TACE + RFA group). After clinical data assessment, tumor size and survival status were not significantly different between the groups as determined by stratified analysis. Before and after surgery, spiral CT radiography and color comparison observed ablation conditions. The tumor necrosis rates after treatment (CR + PR) were 67.4% (29/43) and 91.1% (41/45) for the TACE and combined treatment groups, respectively, and the difference was statistically significant (P<0.05). The quality of life was significantly improved for patients undergoing TACE + RFA compared with the control group. Survival duration was not significantly different in patients undergoing TACE + RFA compared with the control group. In this study, the effect of RFA combined with TACE treatment was better than TACE alone in treating advanced HCC.

Postoperative adjuvant arterial chemoembolization improves the survival of hepatitis B virus-related hepatocellular carcinoma: a retrospective control study.

The survival benefit of postoperative adjuvant transcatheter arterial chemoembolization (TACE) remains controversial. We aim to investigate the survival effect of postoperative adjuvant TACE on the prognosis of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients (stage B, the Barcelona Clinic Liver Cancer staging). Sixty consecutive HBV-related HCC patients (stage B) from February 2006 to May 2009 undergoing surgical resection were included in this study. Of these 60 patients, 34 patients underwent surgery only (Group A) and 26 patients underwent surgery plus TACE (Group B). We followed-up until May 2013. Overall survival rates as well as prognostic factors were analyzed by the Kaplan-Meier method, the log-rank test or Cox's proportional hazard model. All patients' data were collected from the hospital medical records, which were described precisely after accurate clinical samples detection. The 1-, 2-, and 3-year overall survival rates in surgery-only group were 58.8, 32.4 and 12.6%, and the rates in surgery plus TACE group were 73.1, 61.5, and 48.9%, respectively (P = 0.033). The median survival time of the two groups after surgery and surgery plus TACE was 15.0 months [95% confidence interval (CI) 10.714-19.286] and 35.0 months (95% CI 20.974-49.026). In multivariate analysis, hemoglobin, HBeAg, peripheral blood regulatory T cells and tumor size were independent prognostic elements for HBV-related HCC patients (stage B). Postoperative adjuvant TACE improves the survival of patients with HBV-related HCC (stage B) after curative resection compared to surgery only.

Immediate Radical Therapy or Conservative Treatments When Meeting the Milan Criteria for Advanced HCC Patients After Successful TACE

Background and aimsMany advanced hepatocellular carcinoma (HCC) cases can be successfully downstaged into the Milan criteria; however, immediate radical therapy cannot be applied to all such patients for various reasons. Of the patients who are not eligible for immediate radical therapy, some accept repeated downstaging therapies and some undergo persistent observation. The aim of the present study was to compare long-term survival between these two groups of patients. Patients and MethodsBetween August 2003 and October 2008, 156 HCC patients successfully received downstaging therapy resulting in compliance with the Milan criteria. Of those, 98 cases accepted radical therapies, including liver transplantation (LT), resection, or radiofrequency ablation (RFA) (group 1), and 58 cases underwent repeated transcatheter arterial chemoembolization (TACE) or persistent observation (group 2). The baseline characteristics, demographic data, downstaging protocol, and information on long-term outcomes were collected and compared. ResultsNo significant differences were observed in the patient demographic data, downstaging protocols, or tumor characteristics between the two groups. The 1-, 3-, and 5-year overall survival rates were 92.9, 82.7, and 78.6 %, respectively, in group 1, whereas these rates were 82.8, 65.5, and 48.3 %, respectively, in group 2 (P = 0.046). Among the 58 patients in group 2, the 1-, 3-, and 5-year overall survival rates were 92.3, 65.4, and 46.2 %, respectively, in the repeated TACE group, and 81.3, 65.6, and 50 %, respectively, in the persistent observation group (P = 0.783). ConclusionImmediate radical therapy should be the first choice for advanced HCC patients who undergo successful TACE, and repeated TACE is unnecessary.

Partial hepatectomy vs. transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan criteria: A RCT

The aim of this randomized comparative trial (RCT) is to compare partial hepatectomy (PH) with transcatheter arterial chemoembolization (TACE) to treat patients with resectable multiple hepatocellular carcinoma (RMHCC) outside of Milan Criteria. This RCT was conducted on 173 patients with RMHCC outside of Milan Criteria (a solitary tumor up to 5 cm or multiple tumors up to 3 in number and up to 3 cm for each tumor) who were treated in our centre from November 2008 to September 2010. The patients were randomly assigned to the PH group or the TACE group. The primary outcome measure was overall survival (OS) from the date of treatment. A multivariate Cox proportional hazards regression analysis was performed to assess the prognostic risk factors associated with OS. The 1-, 2-, and 3-year OS rates were 76.1%, 63.5%, and 51.5%, respectively, for the PH group compared with 51.8%, 34.8%, and 18.1%, respectively, for the TACE group (Log-rank test, χ(2)=24.246, p<0.001). Multivariate Cox proportional hazards regression analysis revealed the type of treatment (hazard ratio, 0.434; 95% CI, 0.293 to 0.644, p<0.001), number of tumor (hazard ratio, 1.758; 95% CI, 1.213 to 2.548, p=0.003) and gender (hazard ratio, 0.451; 95% CI, 0.236 to 0.862, p=0.016) were significant independent risk factors associated with OS. PH provided better OS for patients with RMHCC outside of Milan Criteria than conventional TACE. The number of tumor and gender were also independent risk factors associated with OS for RMHCC.

A meta-analysis of Cinobufacini combined with transcatheterarterial chemoembolization in the treatment of advanced hepatocellular carcinoma.

The aim of this meta-analysis is to evaluate the clinical efficacy of cinobufacini combined with transcatheter arterial chemoembolization (TACE) in the treatment of advanced hepatocellular carcinoma. By searching Medline, the Cochrane central register of controlled trials, EMBSE, ESMO, Wanfang and Chinese National Knowledge Infrastructure (CNKI) databases, the open published clinical trials compared the clinical efficacy of cinobufacini plus TACE versus TACE only in patients with advanced hepatocellular carcinoma were collected. The pooled objective response rate (ORR) and 1 or 2 year survival rate were calculated by Stata11.0 statistical software. Nine studies including a total of 659 subjects (333 in cinobufacini plus TACE and 326 in TACE only) were finally included in this meta-analysis. The pooled analysis demonstrated that cinobufacini plus TACE can significant increase the objective response rate (ORR) compared with TACE only with an relative risk of 1.28 (P = 0.006); The 1-year survival rate in cinobufacini plus TACE group was not significant difference compared with TACE only by pooling the data (RR = 1.24, P = 0.13); But the 2-year survival rate in cinobufacini plus TACE group was much higher than that of TACE only group with an RR of 2.0, (P = 0.001). This meta-analysis demonstrated that cinobufacini combined with TACE can significantly increase the objective response rate and 2-year survival rate compared with TACE only in patients with advanced hepatocellular carcinoma.

Comparison of microwave ablation and transcatheter ablation and transcatheter arterial chemoembolization in the treatment of early hepatocellular carcinoma

Background: Patients with cirrhosis and early stage hepatocellular carcinoma (HCC) may not be candidates for surgical resection due to liver dysfunction. Two common alternative therapies to treat HCC are transcatheter arterial chemoembolization (TACE) and microwave ablation (MWA). We compared outcomes between HCC patients within Milan criteria after initial treatment with these two therapies. Methods: The records of 58 patients diagnosed with HCC within Milan criteria and treated initially with either TACE or MWA were reviewed. Pre-treatment factors, perioperative outcomes and survival were compared between groups. Results: There were 36 patients treated with MWA and 22 with TACE. Pre-treatment AFP levels were higher in the TACE group. Treatment with MWA was associated with progression-free survival (PFS) of 17.1 months versus 8.9 months after TACE (p=0.56). Disease- specific survival (DSS) was higher in the MWA group (median not reached) than the TACE group (32.0 months, p=0.047). Nine (15.5%) patients in this cohort went on to receive liver transplantation. Conclusions: Treatment with either MWA or TACE for patients with cirrhosis and unresectable HCC within Milan criteria is generally safe and initially effective, but recurrence and eventual death due to HCC or cirrhosis is common. These therapies should be a bridge to transplantation for all appropriate candidates.

Comparison of transcatheter arterial chemoembolization and transcatheter arterial chemotherapy infusion for patients with intermediate-stage hepatocellular carcinoma

The aim of the present study was to compare clinical outcomes in patients with intermediate-stage hepatocellular carcinoma (HCC) who underwent the following treatments: transcatheter arterial chemoembolization (TACE) using an epirubicin-mitomycin-lipiodol (EML) emulsion at initial therapy (TACE group; n=145), and transcatheter chemotherapy infusion (TACI) using an EML emulsion at initial therapy (TACI group; n=81). Overall survival (OS) and treatment efficacy in the TACE and TACI groups were retrospectively compared. Prognostic factors associated with OS were examined using univariate and multivariate analyses. Treatment-related mortality was also calculated. The median observation periods were 1.8 years (range, 0.2-9.0 years) in the TACE group and 2.0 years (range, 0.2-8.7 years) in the TACI group. The median survival time and the 1-, 2-, 3- and 5-year cumulative OS rates were 2.68 years and 81.5, 63.4, 43.9 and 32.7%, respectively, in the TACE group, and 2.64 years and 85.0, 60.0, 43.2 and 26.0%, respectively, in the TACI group (P=0.691). The objective response rate was significantly higher in the TACE group compared to the TACI group (80.0 vs. 66.7%; P=0.009). Using multivariate analysis, the Child-Pugh classification (P=0.017), tumor number ≤5 (P=0.045) and des-γ-carboxy prothrombin level >100mAU/ml (P=0.002) were found to be significant predictors linked to OS. In all subgroup analyses involving Child-Pugh classification, maximum tumor size and tumor distribution, the differences in the two groups did not reach statistical significance in terms of OS. Treatment mortality was 0% in the two groups. In conclusion, patients with intermediate-stage HCC had a comparable prognosis when treated with TACI or TACE.

Hepatic Parenchymal Changes following Transcatheter Embolization and Chemoembolization in a Rabbit Tumor Model

ObjectiveTo compare the effects of transcatheter arterial chemoembolization (TACE) with transcatheter arterial embolization (TAE) on liver function, hepatic damage, and hepatic fibrogenesis in a rabbit tumor model.Materials and MethodsThirty-nine New Zealand white rabbits implanted with VX2 tumors in the left liver lobes were randomly divided into three groups: TAE, TACE, and control group. In the TAE group (n = 15), polyvinyl alcohol particles (PVAs) were used for left hepatic artery embolization. In the TACE group (n = 15), the tumors were treated with left hepatic arterial infusions of a suspension of 10-hydroxycamptothecin and lipiodol, followed by embolization with PVAs. In the control group (n = 9), the animals received sham treatment with distilled water. Serum and liver samples were collected at 6 hours, 3 days and 7 days after treatment. Liver damage was measured using a liver function test and histological analyses. Liver fibrogenesis and hepatic stellate cell (HSC) activation were evaluated using Sirius Red and anti-alpha-smooth muscle actin (α-SMA) immunohistochemical stains.ResultsTACE caused liver injury with greater increases in serum alanine aminotransferase and aspartate aminotransferase levels on day 3 (P<0.05). Histological analyses revealed increased hepatic necrosis in adjacent non-tumorous liver tissue from day 3 compared to the TAE group (Suzuki score of 2.33±1.29 versus 1.13±1.18, P = 0.001). HSC activation and proliferation were significantly increased in the TACE group compared to the control group at 3 and 7 days after treatment (0.074±0.014 vs. 0.010±0.006, and 0.088±0.023 vs. 0.017±0.009, P<0.05). Sirius Red staining demonstrated a statistically significant increase in collagen deposition in the livers in the TACE group 7 days after embolization compared to the control group (0.118±0.012 vs. 0.060±0.017, P = 0.05).ConclusionThe results of this animal study revealed that TACE induced prominent hepatocellular damage and hepatic fibrogenesis, which compromised liver function and may be responsible for chronic liver decompensation.

Intra-arterial interleukin-12 gene delivery combined with chemoembolization: anti-tumor effect in a rabbit hepatocellular carcinoma (HCC) model

Interleukin-12 (IL-12), a cytokine naturally secreted by activated dendritic cells and monocytes/macrophages, is known as a key anti-tumor agent in many tumor models, including hepatocellular carcinoma (HCC) models. To evaluate the anti-tumor effect of intra-arterial IL-12 gene delivery alone and in combination with transcatheter arterial chemoembolization (TACE) in rabbit VX2 liver cancer model. Rabbits with VX2 liver tumors were randomized into four groups, eight in each group. After laparotomy and insertion of a 30-gauge needle into the proper hepatic artery, the following interventional procedure protocols were applied: 0.9% saline solution (group A, control), TACE (group B, TACE alone, lipiodol + mitomycin), intra-arterial interleukin-12 gene infusion (group C, IL-12 alone), and intra-arterial interleukin-12 gene infusion in combination with TACE (group D, IL-12 plus TACE). Growth ratio was estimated by computed tomography. To analyze apoptotic index, tumor tissues were explanted for terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) staining, 14 days after therapy. Significant differences of the relative tumor growth ratio were observed in TACE alone group and IL-12 plus TACE group in comparison with control (P < 0.05, ANOVA, Tukey's HSD correction) but not between IL-12 alone and control, or IL-12 plus TACE group and TACE alone group (P > 0.05). Significant changes of the apoptotic index were observed in group D in comparison with remaining three groups (P < 0.05). The difference between group C and group A was not significant statistically (P > 0.05). Intra-arterial interleukin-12 gene therapy combined with TACE has a potent anti-tumor effect in rabbit VX2 liver cancer in comparison with TACE alone.

Outcome evaluation of hepatocellular carcinoma patients after balancing the covariates between groups through propensity score

Objective To balance the covariates by propensity score matching for better evaluating the efficiencies of surgery resection(SR) and transcatheter arterial chemoembolization(TACE) for treatment of early-stage hepatocellular carcinoma(HCC) patients.Methods A total of 350 early-stage HCC patients treated by SR(192 cases) or TACE(158 cases) were collected from Shandong Tumor Hospital(2003 to 2011).Propensity score caliper matching was used to balance the covariance between the two groups.And then the matched data were subjected to survival analysis and the survival rates were compared between the two groups.Results The covariates were imbalanced before matching;the 1-,2-,3-,and 4-year survival rates and the median survival time of SR group were 80.92%,49.44%,33.73%,19.72%,and 2.00 years,respectively;those of TACE group were 80.02%,53.92%,31.21%,13.42%,and 2.40 years,respectively;and log-rank test showed no significant differences in the survival rates between the two treatment groups(P=0.710 8).The covariates were balanced after matching;the 1-,2-,3-,and 4-year survival rates and the median survival time of SR group were 84.22%, 57.68%,36.80%,24.09%,and 2.50 years,respectively;those of TACE group were 73.84%,47.26%,28.31%,10.69%,and 2.00 years,respectively;and log-rank test showed significant difference in the survival rates between the two groups(P=0.018 2).The survival rate of SR group was higher than that of TACE group.Conclusion After reducing the confounding bias by Propensity score matching method,SR showes a better efficiency for early HCC patients compared with TACE.

Percutaneous ethanol injection for liver metastases

Primary liver tumours and liver metastases from colorectal carcinoma are the two most common malignant tumours to affect the liver. The liver is second only to the lymph nodes as the most common site for metastatic disease. More than half of the patients with metastatic liver disease will die from metastatic complications. Percutaneous ethanol injection (PEI) causes dehydration and necrosis of tumour cells accompanied by small vessel thrombosis, leading to tumour ischaemia and destruction. To study the beneficial and harmful effects of percutaneous ethanol injection compared with no intervention, other ablation methods, or systemic treatments in patients with liver metastases. We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, LILACS, and CINAHL up to December 2012. We included all randomised clinical trials assessing the beneficial and harmful effects of percutaneous ethanol injection versus no intervention, other ablation methods, or systemic treatments in patients with liver metastases. We extracted the relevant information on participant characteristics, interventions, study outcome measures, and data on the outcome measures for our review, as well as information on the design and methodology of the studies. Quality assessment of the trials fulfilling the inclusion criteria and data extraction from the trials retrieved for final evaluation were done by one author and checked by a second author. One randomised clinical trial was included, comparing transcatheter arterial chemoembolisation (TACE) + percutaneous intratumour ethanol injection (PEI) versus TACE alone. Forty-eight patients with liver metastases were included; 25 received the intervention with PEI and 23 received TACE alone.Mortality data were not reported. The trial reported the survival data after one, two, and three years. In the TACE + PEI group, 92%, 80%, and 64% of the patients survived after 1, 2, and 3 years respectively; in the TACE group, 78.3%, 65.2%, and 47.8% of the patients survived after 1, 2, and 3 years respectively. The hazard ratio was 0.57 (95% CI 0.19 to 1.67). The local recurrence was 16% in the TACE + PEI group and 39.1% in the TACE group, resulting in a relative risk (RR) of 0.41 (95% CI 0.15 to 1.07). Forty-five tumours (66.2%) out of 68 tumours in total shrunk by at least 25% in the TACE + PEI group versus 31 tumours (48.4%) out of 64 tumours in total in the TACE group (RR 2.08; 95% CI 1.03 to 4.2). The authors reported some adverse events, but with very few details. On the basis of one small randomised trial, it can be concluded that addition of PEI to TACE, as compared with TACE alone, in patients with liver metastases seems to bring no clear benefit in terms of survival and local recurrence. The size of the tumour necrosis was larger in the combined treatment group. No intervention-related mortality or major complications were reported. More trials are needed.

Postoperative adjuvant transcatheter arterial chemoembolization for hepatocellular carcinoma: a prospective study

Objective To evaluate the clinical value of postoperative adjuvant transcatheter arterial chemoembolization(TACE) on the prognosis of hepatocellular carcinoma(HCC) patients after radical hepatectomy using a prospective cohort study.Methods A total of 220 HCC patients underwent radical hepatectomy from Jan.2008 to Dec.2008 and 104 were recruited in the present study.Fifty-six patients(TACE group) received adjuvant TACE one month after hepatectomy,and 48(control group) did not receive any adjuvant therapies.Follow-up was done regularly.The disease-free survival(DFS) time and total survival(TS) were statistically analyzed.Results The median DFS time in TACE group was significantly shorter than that in the control group(11 months vs 13 months,P=0.005).The 1-year,2-year and 3-year recurrence rates were 50%,85.7%,and 89.3% in TACE group and 46.8%,58.3%,and 62.5% in the control group(P=0.005),respectively.Multivariate COX regression analysis indicated that TACE,AFP,intact tumor peplos,liver cirrhosis,vascular invasion and tumor Edmondson-Steiner grade were the risk factors for recurrence(P0.05).The median TS time periods in TACE group and control group were 29(4-41) months and 24(5-59) months(P=0.789),respectively.The 1-year,2-year and 3-year survival rates were 85.6%,59.5%,and 36.5% in TACE group and 75%,50%,and 41.7% in the control group(P=0.789),respectively.Multivariate COX regression analysis indicated that AFP,intact tumor peplos and tumor Edmondson-Steiner grade were correlated with the total survival of patients(P0.05).Conclusion Adjuvant TACE can not improve DFS and TS of HCC patients after radical hepatectomy,and it may even contribute to a poor prognosis.Therefore more attention should be paid in choosing treatment strategy.

Efficacy of postoperative antiviral combined transcatheter arterial chemoembolization therapy in prevention of hepatitis B-related hepatocellular carcinoma recurrence

Background Recurrence of hepatitis B-related hepatocellular carcinoma (HCC) after curative resection is the leading factor influencing the prognosis of the disease. Therefore, further improvement of long-term survival may depend on the prevention and treatment of the recurrent tumor. The aim of this research was to investigate the role of antiviral therapy and postoperative transcatheter arterial chemoembolization (TACE) in the prevention and treatment of hepatitis B-related HCC recurrence. Methods One hundred and twenty patients who underwent curative resection of hepatitis B-related HCC between January 2005 and June 2008 at our hospital were enrolled. Patients were divided into four groups according to the post-operative adjuvant therapy they received, i.e., control, antiviral therapy group, TACE group, and combined group. The disease-free survival (DFS) and the 12-, 24-, 36-month cumulative recurrence rates were studied. Results There was no significant difference between isolated postoperative antiviral therapy group and control in terms of disease-free survival (P=0.283), while it was significantly higher in the TACE group compared to control (P=0.019). In all patients, however, viral prophylactic therapy combined with/without TACE brought a favorable result compared to those only with/without TACE (P &lt;0.001). Similarly, no matter combined with or without antiviral treatment, postoperative TACE prolonged DFS (P=0.015). Naturally, a combination of viral prophylactic therapy on the baseline TACE significantly benefited patients' postoperative DFS (P=0.047) and vice verse (P=0.002). The 24-month cumulative recurrence rates of combined group were significantly lower than that of isolated control group and antiviral therapy (P &lt;0.001 and P=0.011 respectively). However, 36-month recurrence rate was significantly different in the control group compared to the TACE group and combined group (P=0.040 and 0.002 respectively); same as the antiviral group compared to the combined group (P=0.034). Conclusions Post-operative TACE prevents early recurrence while antiviral therapy prevents late recurrence of HCC. Combination of antiviral therapy and TACE are suggested for prevention in HCC patients with high risk of recurrence.

Stereotactic body radiation therapy combined with transcatheter arterial chemoembolization for small hepatocellular carcinoma

To compare the tumor control and safety of stereotactic body radiation therapy (SBRT) combined with transcatheter arterial chemoembolization (TACE) for small, solitary, and hypervascular hepatocellular carcinoma (HCC) with TACE alone. Three hundred and sixty-five HCC patients who had solitary, ≤ 3 cm, and hypervascular nodule were treated with TACE. Among them, 30 patients followed by SBRT (SBRT group) and 38 patients without additional therapy and previous HCC treatment (control group) were enrolled in this retrospective cohort study. Local tumor progression, complication, and disease-free survival were compared between these groups. There was no difference in clinical background between these groups. Complete response to therapy was noted in 29 (96.3%) patients of the SBRT group, and in only one (3.3%) patient of the TACE group (P < 0.001). None of the patients developed acute hematologic toxicity of more than Common Terminology Criteria for Adverse Events Grade 3 during and after the treatment. Furthermore, none of the SBRT group developed radiation-induced liver damage. Disease-free survival of the 12 patients without previous HCC treatments in SBRT group was significantly superior to that in control group (15.7 months vs 4.2 months; P = 0.029). The results indicated that SBRT combined with TACE is a safe and effective modality for locoregional treatment of small solitary primary HCC, and could be potentially a suitable option.