BackgroundTo compare the efficacy and safety between conventional transarterial chemoembolization (cTACE) and drug-eluting beads TACE (DEB-TACE) in patients with infiltrative hepatocellular carcinoma (iHCC).MethodsA total of 89 iHCC patients who were treated with either cTACE (n = 33) or DEB-TACE (n = 56) between April 2013 and September 2017 were included in this retrospective study. Patients with the situations that might have a poor outcome were defined as advanced disease including Child-Pugh class B, bilobar lesions, tumor size greater than 10 cm, ECOG 1–2, tumor burden of 50–70%, and the presence of ascites, arterioportal shunt (APS), and portal venous tumor thrombus (PVTT). The tumor response was measured 1-month and 3-month after the procedure. Progression-free survival (PFS) was calculated. Toxicity was graded by Common Terminology Criteria for Adverse Events v5.0 (CTCAE v5.0). The differences in tumor response, PFS, and toxicity were compared between the DEB-TACE group and cTACE group.ResultsAt 1-month and 3-month after the procedure, the objective response rate (ORR) in the overall study population was similar in DEB-TACE group and cTACE group. The disease control rate (DCR), at 1-month after the procedure, was significantly higher in the patients treated with DEB-TACE relative to those treated with cTACE (P = 0.034), while after 3 months, the difference did not differ between two groups. DEB-TACE showed a higher DCR than cTACE in patients with tumor size greater than 10 cm (P = 0.036) or associated with APS (P = 0.030) at 1-month after the procedure, while after 3 months, the difference was only noted in patients with APS (P = 0.036). The median PFS in DEB-TACE group was 96 days, while in cTACE group was 94 days, and there was no difference in PFS between two groups (P = 0.831). In the side effect analysis, abdominal pain (P = 0.034) and fever (P = 0.009) were more frequently present in the cTACE group than DEB-TACE group, but there was no difference in high grade liver toxicity between the two groups.ConclusionsCompared to cTACE, DEB-TACE offers slightly better DCR and tolerability for iHCC patients, particularly in patients associated with APS and large tumor size. However, DEB-TACE does not provide higher PFS than cTACE.
With modern management of primary liver cancer shifting towards non-invasive diagnostics, accurate tumor classification on medical imaging is increasingly critical for disease surveillance and appropriate targeting of therapy. Recent advancements in machine learning raise the possibility of automated tools that can accelerate workflow, enhance performance, and increase the accessibility of artificial intelligence to clinical researchers. We explore the use of an automated Tree-Based Optimization Tool that leverages a genetic programming algorithm for differentiation of the two common primary liver cancers on multiphasic MRI. Manual and automated analyses were performed to select an optimal machine learning model, with an accuracy of 73–75% (95% CI 0.59–0.85), sensitivity of 70–75% (95% CI 0.48–0.89), and specificity of 71–79% (95% CI 0.52–0.90) on manual optimization, and an accuracy of 73–75% (95% CI 0.59–0.85), sensitivity of 65–75% (95% CI 0.43–0.89) and specificity of 75–79% (95% CI 0.56–0.90) for automated machine learning. We found that automated machine learning performance was similar to that of manual optimization, and it could classify hepatocellular carcinoma and intrahepatic cholangiocarcinoma with an sensitivity and specificity comparable to that of radiologists. However, automated machine learning performance was poor on a subset of scans that met LI-RADS criteria for LR-M. Exploration of additional feature selection and classifier methods with automated machine learning to improve performance on LR-M cases as well as prospective validation in the clinical setting are needed prior to implementation.
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