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OBJECTIVE:To investigate the safety and efficacy of transcatheter arterial chemoembolization (TACE) with embospheres for the treatment of unresectable hepatocellular carcinoma (HCC). METHODS:Patients with unresectable HCC who were treated with TACE followed by embosphere treatment (Embo-TACE) or conventional TACE (cTACE) between May 2010 and March 2014 were retrospectively included in this study. The Embo-TACE group received lipiodol and chemotherapeutic agent emulsion, followed by embospheres. The cTACE group received lipiodol and chemotherapeutic agent emulsion, followed by gelatin sponge pellets. Time to progression (TTP), overall survival (OS), overall response rate (ORR), and safety were compared between the two groups. Univariate and multivariate regression analyses of the factors affecting survival were conducted. RESULTS:The median TTP and OS in the Embo-TACE group were significantly longer than those in the cTACE group (TPP: 7.0 months vs 5.4 months, P = 0.035; OS: 15 months vs 12 months, P = 0.032). Seven days after the first TACE treatment, alanine aminotransferase level was higher in the cTACE group than in the Embo-TACE group (P = 0.015). The ORR did not significantly differ between the two groups (P = 0.827). Additional therapy and local responses one month after the first TACE treatment were associated with OS. CONCLUSIONS:Embo-TACE resulted in a significant improvement in TTP and OS for patients with unresectable HCC, compared with cTACE. Furthermore, Embo-TACE was better tolerated. Additional therapy and local responses one month after the first TACE were independent prognostic factors for OS.

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Purpose: Unresectable intrahepatic cholangiocarcinoma (ICC) has a poor prognosis. The aim of this study was to evaluate the efficacy and safety of apatinib for patients with unresectable ICC. Patients and Methods: A total of 10 patients with unresectable ICC were enrolled for this single-center observational study between March 2, 2016, and August 27, 2019. Subjects received 500 mg apatinib on a daily basis. Tumor response was assessed by 1.1 response evaluation criteria in solid tumors. The progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. The drug-related adverse effects were also monitored. Results: Based on the follow-up computed tomography and magnetic resonance imaging after treatment, 4 (40.0%), 4 (40.0%), and 2 (20.0%) patients achieved a partial response, stable disease, and progression of the disease, respectively. The response rate and disease control rate were 40.0% and 80.0%, respectively. The median PFS was 4.5 months (95% confidence interval: 3.157~5.843 months); the median OS was 6.5 months (95% confidence interval: 4.744~8.256 months). Furthermore, 3-, 6-, and 9-month OS rates were 77.5%, 61.7%, and 15.0%, respectively. The most common hematologic grade 3 adverse event was neutropenia (10%); the most common nonhematologic grade 3 adverse events were hypertension (20.0%) and hand-foot syndromes (20.0%). No treatment-related grade 4 or 5 adverse events were recorded. Conclusion: Apatinib revealed to have antitumour activity in unresectable ICC patients, with manageable toxicities, and thus might be used as a new treatment option for patients with unresectable ICC.

Objective: The aim of our study was to evaluate the efficacy and incidence of complications of percutaneous transhepatic biliary drainage (PTBD) as palliative treatment of obstructive jaundice caused by metastatic gastric cancer. Methods: Hospital records were reviewed for 32 consecutive patients with biliary obstruction caused by metastatic gastric cancer who underwent PTBD at our institution between October 2004 and April 2010. Patients (23 males and 9 females) age ranged from 35 to 72 years. The indexes of hepatic function before PTBD and within one month after PTBD were compared. The incidence of complications and corresponding treatments were also documented. Results: The level of obstruction was defined as the distal bile duct (beyond the level of the liver hilum) in 22 patients (group 1) and the liver hilum in 10 patients (group 2). Successful decompression of the biliary system after PTBD was defined by a total bilirubin decrease of more than 30% of the baseline value. Success rates were 100% (22/22) for group 1, 70% (7/10) for group 2, and 90.6% (29/32) for all patients. Differences in success rates between group 1 and group 2 were significant (P = 0.024). Serum TBIL, ALT, and AST significantly decreased from (292.8 ± 179.9) μmol/L, (174.5 ± 107.4) IU/L, (159.9 ± 103.9) IU/L before PTBD to (111.5 ± 92.5) μmol/L, (58.5 ± 46.3) IU/L, (59.6 ± 48.9) IU/L, respectively within one month after PTBD (P < 0.05). Complications associated with PTBD included cholangitis in 13 patients (40.5%), drainage tube displacement in 6 patients (18.8%), hemobilia in 4 patients (12.5%), tube occlusion in 2 patients (6.3%), and pancreatitis in 1 patient (3.1%). All complications were successfully treated with appropriate measures. Conclusion: Hepatic function can be improved by PTBD without serious complications in patients with obstructive jaundice caused by metastatic gastric cancer.

BACKGROUND In microwave ablation (MWA), although computed tomography (CT) scanning can overcome gas interference, it cannot achieve real-time localization. Therefore, the puncture technique is more important in CT-guided ablation. AIM To compare the fine needle-assisted puncture (FNP) positioning technique and the conventional puncture (CP) technique for the safety and efficacy of CT-guided MWA in treating hepatocellular carcinoma (HCC). METHODS This retrospective study included 124 patients with 166 tumor nodules from February 2018 and June 2021. Seventy patients received CT-guided MWA under the FNP technique (FNP group), and 54 patients received MWA under the CP technique (CP group). Intergroup comparisons were made regarding local tumor progression (LTP), recurrence-free survival (RFS), overall survival (OS), and complications. The influencing variables of LTP and RFS were analyzed through univariate and multivariate regressions. RESULTS The 1-, 2-, and 3-year cumulative incidences of LTP in the FNP group were significantly lower than those in the CP group (7.4%, 12.7%, 21.3% vs 13.7%, 32.9%, 36.4%; P = 0.038). The 1-, 2-, and 3-year RFS rates in the FNP group were significantly higher than those in the CP group (80.6%, 73.3%, 64.0% vs 83.3%, 39.4%, and 32.5%, respectively; P = 0.008). The FNP technique independently predicted LTP and RFS. Minor complications in the FNP group were lower than those in the CP group ( P < 0.001). The difference in median OS was insignificant between the FNP and CP groups ( P = 0.229). CONCLUSION The FNP technique used in CT-guided MWA may improve outcomes in terms of LTP, RFS, and procedure-related complications for HCC.

Objective: To evaluate the efficacy of percutaneous ethanol injection (PEI) in the adjuvant treatment of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) by primary end points of time to progress (TTP). Methods:The study population consisted of 73 consecutive patients with inoperable HCC (China Classification System IIA/ IIB). Among them, 22 patients were treated with TACE and PEI (experimental group), and the rest 51 were treated only with TACE (control group), and then the time to progress (TTP) and overall survival (OS) of these two groups were analyzed. Results: The median TTP was 10 months [95% confidence interval (CI), 7.9-12.1 months] in experimental group and 6 months (95% CI, 4.7-7.3 months) in control group. The 3-month,6-month, and 1-year Progression Free Survival (PFS) rates were respectively 77.3%, 63.6%, and 48.1% in experimental group, and 76.5%, 42.15%, and 24.8% in control group. The TTP of experimental group was significantly longer than that of control group (P < 0.05). The median survival period was 17 months [95% confidence interval (CI), 11-23 months] of experimental group and 12 months (95% CI, 10-14 months) of control group (P > 0.05). Conclusion: Compared with single TACE, the combination of TACE and PEI can obviously postpone disease progress and prolong survival of HCC patients.