Survival analysis of 230 patients with unresectable hepatocellular carcinoma treated with bland transarterial embolization

Abstract

Locoregional therapies for hepatocellular carcinoma (HCC) include endovascular treatments such as chemoembolization (TACE) and bland embolization (TAE). TACE is the most adopted technique, despite a lack of definitive evidence of superiority over TAE, which is less costly and better tolerated due to the absence of chemotherapy. However, few studies have reported data on TAE monotherapy for unresectable HCC. We report our results in a cohort of 230 patients with unresectable HCC treated with TAE (TAE with 40-100micron microparticles, TAE with microparticles plus n-butyl-2-cyanoacrylate, TAE with Lipiodol) over the course of seven years. Thirty-seven patients (14%) were down-staged during observation and also received a percutaneous ablation. We observed 1-, 2-, 3-, 4-and 5year rates of 84,8%, 58,7%, 38,3%, 28,3%, and 18,7%. Patients who also received percutaneous treatment performed best. Our results broaden the body of evidence for the use of TAE in advanced HCC.

Changes in prognostic factors for patients with hepatocellular carcinoma underwent transarterial chemoembolization with the transition of the time: Child-Pugh class, Albumin-Bilirubin grade, and then

“…The usefulness of ALBI grade in predicting overall survival has been validated in patients with HCC underwent liver resection (2), radiofrequency ablation (3), and tyrosine kinase inhibitors (4,5). The prognostic impact of ALBI grade has also been reported in patients with intermediatestage HCC underwent transarterial chemoembolization (TACE) (6). In addition, Zhao et al recently demonstrated that ALBI grade was better than Child-Pugh class in terms of stratifying prognosis in patients with HCC underwent TACE (7).…”

Sarcopenia as a predictor of survival in patients undergoing bland transarterial embolization for unresectable hepatocellular carcinoma

“…All TAEs were performed without the use of intra-arterial chemotherapeutic drugs. Technical variations included microparticles TAE (P-TAE), microparticles plus cyanoacrylate glue TAE (G-TAE) and Lipiodol TAE (L-TAE), as previously reported by our group [6]. All procedures were performed by two senior operators and two junior interventional radiologists with at least three years' experience in an angiographic suite (V5000 Philips Medical System, Amsterdam, The Netherlands), equipped with cone-beam CT (Siemens Artis-Zee, Munich, Germany).…”

“…Particularly, its prognostic value has been analyzed in patients with HCC undergoing surgical resection, TACE therapy, Sorafenib therapy, or transplantation. In our Institution, however, TAE is preferred over TACE in patients with unresectable HCC as it provides similar survival rates without the side effects related to arterial chemotherapy [6,18]. Briefly, the aim of TAE therapy, as opposed to TACE, is to deploy the embolizing agent from a distal stance, in close proximity to the tumor, to achieve the maximum ischemic effect and promote necrosis of tumoral cells.…”

“…Among the different techniques, bland transarterial embolization (TAE) has been shown to improve patient survival and tumor response with similar efficacy when compared to transarterial chemoembolization (TACE) or transarterial radioembolization (TARE) [4,5]. Relying only on the ischemic effect of small microparticles, TAE does not cause the side effects known to TACE and it is less expensive and less invasive than TARE [6]. Survival rates following TAE are extremely heterogeneous as patients who undergo TAE vary significantly in terms of liver function, age and concomitant comorbidities.…”

Treatment Strategy of Transarterial Chemoembolization for Hepatocellular Carcinoma

“…Therefore, a superselective approach and careful observation of pulmonary shunting is recommended in the use of small-sized particles. In a report by Lanza et al [49], 40-or 100-µm Embozene (Varian, Austin, TX, USA) could be safely used in the superselective bland embolization procedure.…”