Efficacy and Safety of Transarterial Chemoembolization with a Three-Stage Mixed Chemoembolic Regimen for Large Unresectable Hepatocellular Carcinoma

Abstract

Objective This study aimed to assess the treatment response, survival outcomes, and safety of a novel transarterial chemoembolization (TACE) technique with a three-stage mixed chemoembolic regimen (M-TACE) in patients with large unresectable hepatocellular carcinoma (HCC) measuring more than 5 cm in maximum diameter. Methods Between January 2017 and March 2023, a total of 82 patients were enrolled in this retrospective cohort study. Treatment response was assessed in the first month after M-TACE; progression-free survival and overall survival (OS) were evaluated. The prognostic factors associated with patient survival were statistically analyzed by the Cox regression model. Adverse events were recorded. Results The maximum diameter of the tumors ranged from 5.3 cm to 20.0 cm (mean 10.71 cm). The objective response (OR) and disease control rates were 74.4 and 92.7%, respectively, at 1-month follow-up. The median survival time was 22 months (95% CI, 13.10–30.90 months). The OS rates were 82.0% at six months, 62.5% at one year, and 43.0% at two years. Targeted therapy and/or immunotherapy ( P =0.001) and tumor response at one month ( P =0.020) were protective factors for OS. In terms of safety, no major complications occurred and the only observed decrease within the normal range occurred in albumin and platelet levels one month after the embolization procedure. This decrease in levels did not show a significant relationship with the OR rates. Conclusion M-TACE demonstrated a promising objective tumor response, making it a viable and effective treatment option for patients with large unresectable HCC.

Efficacy and safety analysis of selective hepatic vein occlusion combined with arterial chemoembolization versus conventional transarterial chemoembolization in the treatment of hepatocellular carcinoma

“…Safety-wise, the rate of AEs did not significantly differ between the two groups, and notably, there were no events related to hepatic vein occlusion in the O-TACE group. The most common AE was abdominal pain, aligning with prior studies ( 12 , 24 - 26 ). Liver function in both groups returned to baseline levels 1 month post-surgery, with the O-TACE group displaying a significant reduction in transaminases from baseline, confirming the safety of O-TACE for HCC treatment.…”

“…In our study the CR rate of patients in the C-TACE group was lower than that of previous studies, which may be due to the possible selective bias of fewer patients enrolled in this study on the one hand, and the inclusion of some patients with multiple nodes in this study on the other hand. In the context of recent advancements, novel embolization techniques such as balloon-assisted TACE (B-TACE) and microsphere-enhanced TACE (M-TACE) have been introduced with the aim of improving local response in HCC patients ( 11 , 12 ). Research by Kim et al indicates that patients with an initial CR exhibit the longest OS, notably comparing to those who achieve a CR after multiple sessions or who attain a PR as their best outcome ( 13 ).…”