Journal
EUROPEAN RADIOLOGY
Volume 31, Issue 11, Pages 8291-8301Publisher
SPRINGER
DOI: 10.1007/s00330-021-07834-9
Keywords
Chemmembolizatioin; therapeutic; Carcinoma; hepatocellular; Portasystemic shunt; transjugular intrahepatic
Funding
- National Natural Science Foundation of China [81701799, 81671797]
- Natural Science Foundation of Guangdong Province [2016A030310177]
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DEB-TACE is safe and effective in HCC patients with a TIPS and potentially superior to cTACE in terms of complications, liver toxicities, OS, TTP, and ORR.
Objectives This study aims to compare the safety and effectiveness between transarterial chemoembolization (TACE) with drug-eluting beads (DEB-TACE) and conventional TACE (cTACE) using lipiodol-based regimens in HCC patients with a transjugular intrahepatic portosystemic shunt (TIPS). Methods This retrospective study included patients with patent TIPS who underwent TACE from January 2013 to January 2019 that received either DEB-TACE (DEB-TACE group, n = 57) or cTACE (cTACE group, n = 62). The complications, liver toxicity, overall survival (OS), time to progression (TTP), and objective response rate (ORR) were compared between the groups. Results Altogether, 119 patients (50 +/- 11 years, 107 men) were evaluated. The incidence of adverse events, including abdominal pain within 7 days (45.6% vs 79.0%, p < 0.001) and hepatic failure within 30 days (5.3% vs 19.4%, p = 0.027), were significantly lower in the DEB-TACE group than in the cTACE group. Compared to the cTACE group, the DEB-TACE group also showed mild liver toxicities in terms of increased total bilirubin (8.8% vs 22.6%), alanine aminotransferase (5.3% vs 21.0%), and aspartate aminotransferase (10.5% vs 29.0%) levels. The DEB-TACE group had better ORR than the cTACE group (70.2% vs 50.0%). The median OS and TTP were longer in the DEB-TACE group (11.4 vs 9.1 months, hazard ratio [HR] = 2.46, p < 0.001; 6.9 vs 5.2 months, HR = 1.47, p = 0.045). Multivariable analysis showed that alpha-fetoprotein levels, Barcelona clinic liver cancer stage, and treatment allocation were independent predictors of OS. Conclusion DEB-TACE is safe and effective in HCC patients with a TIPS and is potentially superior to cTACE in terms of complications, liver toxicities, OS, TTP, and ORR.
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