ABSTRACT
ObjectiveTo investigate the value of ABCR clinical scoring system in guiding repeated transcatheter arterial chemoembolization (TACE) therapy for patients with hepatocellular carcinoma (HCC) and the treatment strategies for patients with an ABCR score of 1-3. MethodsThe patients with HCC who underwent TACE in The First Affiliated Hospital of Soochow University from January 2008 to December 2017 were enrolled. In order to investigate the effect of repeated TACE in patients with different ABCR scores, 229 patients who underwent repeated TACE consecutively (at least twice, without systemic therapy) were enrolled as group A, which was further divided into group A1 with 92 patients (an ABCR score of ≤0), group A2 with 78 patients (an ABCR score of 1-3), and group A3 with 59 patients (an ABCR score of ≥4). In order to investigate the survival time of patients with an ABCR score of 1-3 who received different regimens after first TACE therapy, 118 patients with an ABCR score of 1-3 who received TACE for the first time were enrolled as group B, which was further divided into group B1 with 78 patients (treated with TACE after first TACE therapy), group B2 with 21 patients (treated with TACE combined with sorafenib), and group B3 with 19 patients (treated with sorafenib alone). The survival of the above groups of patients were analyzed. The Fisher’s exact test was used for comparison of categorical data between groups, the Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison of survival time between groups. ResultsThe median survival time was 320 months (95% confidence interval ［CI］: 27.7-36.3) in group A1, 10.3 months (95%CI: 8.4-12.2) in group A2, and 4.6 months (95%CI: 3.7-5.5) in group A3. Group A1 had a better survival time than group A2 (χ2=106.99, P＜0.01), and group A2 had a better survival time than group A3 (χ2=49.66, P＜0.01). The median survival time was 10.3 months (95%CI: 8.4-12.2) in group B1, 14.8 months (95%CI: 7.8-21.8) in group B2, and 6.0 months (95%CI: 4.6-7.4) in group B3, and group B2 had a better survival time than group B1 (χ2=6.80, P＜0.01) and group B3 (χ2=29.89, P＜0.01). ConclusionThe ABCR score has a certain guiding significance for the treatment of HCC patients. Repeated TACE may be considered for patients with an ABCR score of ≤0, while patients with an ABCR score of ≥4 may not benefit from further TACE therapy, and TACE combined with sorafenib might bring maximum benefits to patients with an ABCR score of 1-3.
ABSTRACT
ObjectiveTo investigate the clinical effect and safety of transarterial chemoembolization (TACE) with ultra-liquid iodized oil combined with drug-eluting beads in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage B/C hepatocellular carcinoma (HCC). MethodsA retrospective analysis was performed for the clinical data of 51 patients with BCLC stage B/C HCC who underwent TACE with ultra-liquid iodized oil combined with drug-eluting beads in The First Affiliated Hospital of Soochow University from May 2016 to September 2018. Liver function was observed before treatment and at 3 days, 7 days, and 1 month after treatment, and adverse events and complications were recorded in detail. Modified Response Evaluation Criteria in Solid Tumors was used to evaluate clinical outcome at 1 and 3 months after surgery. The t-test was used for comparison of continuous data between two groups. ResultsSuperselective TACE procedure was completed in all 51 patients. At 1 month after surgery, the target lesions had a disease remission rate of 70.6% and a disease control rate of 96.1%, while at 3 months after surgery, the target lesions had a disease remission rate of 64.0% and a disease control rate of 880%. Of all 51 patients, 5 (9.8%) experienced acute liver injury at 3 days after surgery, and there were significant changes in alanine aminotransferase (ALT), aspartate aminotransferase, total bilirubin (TBil), and albumin (Alb) (t=-5.454, -3.997, -5.346, and 7212, all P＜0.001). There were also significant changes in ALT, TBil, and Alb at 7 days after surgery (t=-3.177, -3.665, and 3194, all P＜0.05). Of all 51 patients, 35 (68.6%) experienced grade 1 or 2 adverse events at 1 month after surgery, and no complications of liver failure, liver abscess, bile tumor, and gastrointestinal bleeding were observed. One patient died of multiple organ failure due to tumor progression on day 61 after surgery. ConclusionTACE with ultra-liquid iodized oil combined with drug-eluting beads is safe and effective in the treatment of BCLC stage B/C HCC, and further studies are needed to observe long-term efficacy and survival benefit.
ABSTRACT
Objective To summarize the risk factors, the diagnostic and therapeutic approaches, and the outcomes of the ruptured primary hepatocellular carcinoma (PHC) occurred after transcatheter arterial chemoembolization (TACE) in order to make a further understanding of this complication. Methods The clinical data of 8 patients with ruptured PHC after TACE, who were encountered at the First Affiliated Hospital of Suzhou University during the period from Sep. 2007 to Sep. 2013, were retrospectively analyzed. Results A total of 1379 times of TACE were performed in 678 patients with PHC. Among the 678 patients, 8 developed rupture of PHC with bleeding after TACE. The overall incidence was 1.2%. The mean diameter of the tumors in the 8 patients was (11.5 ± 2.6) cm, ranging from 7.6 cm to 15.9 cm. All the lesions were located at the peripheral region close to the liver capsule, and most of them protruded outward. Five cases had coexisting portal hypertension. The average dosage of Lipiodol used in TACE was (14.9 ± 4.5) ml with a range of (8 - 20) ml. Of the 8 patients, emergency transcatheter embolization was carried out in 4 and medical management was employed in other 4. Seven patients died as all active emergency treatments failed. Only one patient, who had received emergency transcatheter embolization, survived the ruptured PHC. Conclusion Rupture of primary hepatocellular carcinoma after TACE is a rare, but very serious complication. Its occurrence may be related to lesion’s characteristics, such as large tumor size, superficial location and protrusion from the liver surface, etc. Besides, interventional management, e.g. without use of solid embolic material to enhance the embolization effect, may also be responsible for the rupture.