ABSTRACT
Objective To explore the efficacy, safety and prognostic factors of drug-eluting bead-transarterial chemoembolization (DEB-TACE) in treatment of the patients with early and middle stage hepatocellular carcinoma (HCC). Methods Twenty-six early and middle stage HCC patients receiving DEB-TACE treatment were enrolled in this prospective cohort study. Modified response evaluation criteria in solid tumors (mRECIST) was used to evaluate the efficacy of DEB-TACE treatment. The deadline for follow-up was Dec. 20, 2017, and the progression free survival (PFS) and overall survival (OS) were recorded. Multivariate logistic regression model and Cox proportional regression model were used to analyze the factors affecting the efficacy and prognosis. Results A total of 32 DEB-TACE treatment were performed in 26 patients. Treatment-related adverse events were recorded in 31 DEB-TACE treatments. Perioperative pain frequency was 15 times (48.4%), including mild pain 10 times (32.3%) and moderate pain 5 times (16.1%); and fever frequency was 10 times (32.3%) and gastrointestinal reaction was 5 times (16.1%). Within 3 months of DEB-TACE treatment, the overall response rate (ORR) was 65.4% (17/26), and disease control rate (DCR) was 84.6% (22/26). Compared with the patients with maximum diameter of tumors=50 mm, the patients with maximum diameter of tumors<50 mm had a significantly higher ORR (92.3% [12/13] vs 38.5% [5/13], P=0.013). Compared with the patients with Barcelona stage B, the patients with Barcelona stage A had a significantly higher ORR (81.3% [13/16] vs 40.0% [4/10], P=0.031). The follow-up ranged from 2.9 to 20.0 months (median 7.2 months), median PFS was 11.9 months (95% CI 5.0-18.9 months), and median OS was 14.6 months (95% CI 9.9-19.2 months). Multivariate logistic regression revealed that tumor maximum diameter=50 mm was an independent predictor of poor ORR (P=0.036). Cox proportional regression model analysis showed that no clinicopathological characteristics were independent predictors of PFS or OS. Conclusion DEB-TACE treatment is an effective and safe method for early and middle stage HCC patients, and maximum diameter of tumor=50 mm can be used as an independent prognostic biomarker.
ABSTRACT
Objective To conduct a Meta-analysis for assessing the therapeutic efficacy and safety of doxorubicin-eluting bead transcatheter arterial chemoembolization (DEB-TACE) vs conventional TACE (C-TACE) in the treatment of hepatoeellular carcinoma (HCC).Methods The relevant studies on DEB-TACE and C-TACE for HCC were searched from PubMed,Web of Science and CK1N databases.The tumor responds and adverse events in the selected studies were analyzed with RevMan5.0 statistical software.Moreover,publication bias was assessed by a funnel plot.Results Thirteen studies with 1 325 HCC patients were finally included in this analysis.The tumor response to DEB-TACE was better than that to C-TACE (OR:2.28;95％CI [1.75,2.96];P＜0.001 0).The risk of adverse events in DEB-TACE group was also lower than that in C-TACE group (RR:0.56;95％ CI [0.32,0.97];P=0.04).Conclusion Compared with C-TACE,DEB-TACE is more effective and has lower risk of adverse events in the treatment of HCC.
ABSTRACT
The aim of our study was to assess the efficacy, safety, and prognostic factors of drug-eluting bead transarterial chemoembolization (DEB-TACE) in Chinese hepatocellular carcinoma (HCC) patients. Patients (n=102) diagnosed as primary HCC were consecutively enrolled in this retrospective cohort study. Treatment responses were assessed following the modified Response Evaluation Criteria in Solid Tumors. Progression-free survival (PFS) and overall survival (OS) were evaluated, and adverse events (AEs) as well as liver function-related laboratory indexes of all DEB-TACE records (N=131) were assessed. Complete response (CR) rate, objective response rate, and disease control rate were 51.0, 87.3, and 95.1%, respectively, at 1-3 months post DEB-TACE. The mean PFS and OS were 227 (95%CI: 200-255) days and 343 (95%CI: 309-377) days, respectively. Multivariate logistic regression revealed that portal vein invasion and abnormal total protein (TP) were independent predictive factors for worse CR, and multivariate Cox's regression analysis showed that multifocal disease independently correlated with shorter PFS. Most of the liver function-related laboratory indexes worsened at 1 week but recovered at 1-3 months post-treatment, only the percentage of patients with abnormal ALP increased at 1-3 months. In addition, 112 (85.5%), 84 (64.1%), 53 (40.5%), 40 (30.5%), and 16 (12.2%) patients had pain, fever, nausea, vomiting, and other AEs, respectively. DEB-TACE is efficient and safe in Chinese HCC patients, and portal vein invasion, abnormal TP level as well as multifocal disease could be used as unfavorable prognostic factors to DEB-TACE treatment.