Comparison of Trans-Arterial Chemoembolization and Bland Embolization for the Treatment of Hepatocellular Carcinoma: A Propensity Score Analysis

Abstract

No definitive conclusion could be reached about the role of chemotherapy in adjunction of embolization in the treatment of hepatocellular carcinoma (HCC). We aim to compare radiological response, toxicity and long-term outcomes of patients with hepatocellular carcinoma (HCC) treated by trans-arterial bland embolization (TAE) versus trans-arterial chemoembolization (TACE). We retrospectively included 265 patients with HCC treated by a first session of TACE or TAE in two centers. Clinical and biological features were recorded before the treatment and radiological response was assessed after the first treatment using modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Correlation between the treatment and overall, progression-free and transplantation-free survival was performed after adjustment using a propensity score matching: 86 patients were treated by bland embolization and 179 patients by TACE, including 44 patients with drug-eluting beads and 135 with lipiodol TACE, 89.8% of patients were male with a median age of 65 years old. Cirrhosis was present in 90.9% of patients with a Child Pugh score A in 84% of cases. After adjustment, no difference in the rate of AE, including liver failure, was observed between the two treatments. TACE was associated with a significant increase in complete radiological response (odds ratio (OR) = 8.5 (95% confidence interval (CI): 2.8–25.4)) but not in the overall response rate (OR = 2.2 (95% CI = 0.8–5.8)). No difference in terms of overall survival (p = 0.3905), progression-free survival (p = 0.4478) and transplantation-free survival (p = 0.9020) was observed between TACE and TAE. TACE was associated with a higher rate of complete radiological response but without any impact on overall radiological response, progression-free survival and overall survival compared to TAE.

Limitations and Possibilities of Transarterial Chemotherapeutic Treatment of Hepatocellular Carcinoma

“…Thus, it is unclear how much the drug adds to the anti-tumour effect or whether that is mainly caused by ischemia. This uncertainty is supported by the observation that DEM-TACE gives no survival benefit compared to embolization with microspheres without the drug [ 26 , 27 , 28 ].…”

“…It has been suggested that half-loaded microspheres with doxorubicin are associated with greater treatment response and shorter hospital stays [ 25 ]. The fact that no survival benefit has been detected for patients treated with DEM-TACE compared to embolization with microspheres without the drug [ 26 , 27 , 28 ] further highlights the need for increasing the understanding of the exact contribution of ischemia to anthracycline-induced cytotoxicity following DEM-TACE [ 29 ].…”

TRANS-TACE: Prognostic Role of the Transient Hypertransaminasemia after Conventional Chemoembolization for Hepatocellular Carcinoma

“…Conversely, the vast majority of cases at presentation are diagnosed at an intermediate and/or advanced stage, and therefore the only treatment options available nowadays are transarterial chemoembolization (TACE), radioembolization (TARE), or systemic therapies [ 10 , 11 , 12 , 13 ]. In particular, TACE is the most common treatment option in this clinical setting, with 46.4% initial tumors treated with this technique [ 14 ].…”

Impact of sarcopenia on tumor response and survival outcomes in patients with hepatocellular carcinoma treated by trans-arterial (chemo)-embolization

“…Patients were treated with transarterial therapy following standard local protocol[ 14 ]. Each indication of TACE or TAE was validated during multidisciplinary tumor board including a hepatologist, an interventional radiologist, and a liver surgeon.…”