Defining radiation induced liver toxicity in the treatment of hepatocellular carcinoma: Which metric is most predictive for survival?

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 361-361
Author(s):  
Tobias Robert Chapman ◽  
Stephen R. Bowen ◽  
Matthew J. Nyflot ◽  
Smith Apisarnthanarax
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Function ◽  
Tumor Size ◽  
Cox Regression ◽  
Liver Toxicity ◽  
Background Radiation ◽  
Univariate Analysis ◽  
Hepatic Reserve ◽  
Radiation Induced ◽  
Pre Treatment

361 Background: Radiation induced liver disease (RILD) is of critical concern in the treatment of hepatocellular carcinoma (HCC) with radiation therapy (RT). Variability exists in metrics used to define RILD with no consensus on which best predict for overall survival (OS) and RILD-specific survival (RILDSS). We examined the correlation between toxicity metrics and clinical outcomes in a heavily pre-treated population that received RT. Methods: The charts of 37 HCC patients treated from 2013 - 2015 were reviewed retrospectively. At baseline, 62% were Child-Pugh (CP)-A, 32% CP-B and 5% CP-C. The majority (59%) had prior liver-directed therapy (LDT), 43% received stereotactic body RT and 49% proton RT. Pre-treatment, toxicity ( ≤ 6 months from treatment) and outcomes data were collected. Deaths from RILD were scored. Pre-treatment factors and toxicity outcomes were assessed by univariate Cox models for association with OS and RILDSS. Statistically significant predictors formed the basis for stepwise multivariate Cox regression to retain independent predictors of survival. Results: At a median follow-up of 8 months, 14 patients had an increase in CP score ( ≥ 2, n = 7) and 3 had ≥ G3 RTOG transaminitis. There were 11 deaths, 5 from RILD. On univariate analysis (UA), tumor size, pre-treatment liver function, prior LDT and 5 toxicity metrics (CP score increases and transaminitis) were significantly associated with OS. An increase of ≥ 1 CP score (HR 22.7, p = 0.005), pre-treatment ALBI grade (HR 6.0, p = 0.02) and tumor size (HR 1.2, p = 0.01) were independent predictors of OS on multivariate analysis (MVA). Similar factors were associated with RILDSS on UA, including ≥ 2 CP score increase and ≥ G3 ALT elevation; however, only pre-treatment CP score (HR 4.0, p = 0.01) and tumor size (HR 1.5, p = 0.03) were independently predictive on MVA. Conclusions: Pre-treatment liver functional status and tumor size were highly predictive of OS and RILDSS, suggesting that baseline functional hepatic reserve is the primary determinant in developing fatal RILD rather than post-RT changes in liver function. Further work is needed to define dosimetric parameters and pre-treatment factors that predict RILD toxicity.

Evaluation of liver toxicity using Child-Pugh, MELD, and MELD-Na following stereotactic body radiation therapy (SBRT) of hepatocellular carcinomas.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 365-365
Author(s):  
Louis Lu ◽  
Eman ElAlfy ◽  
Daniel Wahl ◽  
Matthew H. Stenmark ◽  
Theodore Steven Lawrence ◽  
...  
Keyword(s):  
Time Course ◽  
Liver Toxicity ◽  
Background Radiation ◽  
Univariate Analysis ◽  
Vein Thrombosis ◽  
Point Increase ◽  
Chi Squared ◽  
Radiation Induced ◽  
The University ◽  
Hep B

365 Background: Radiation-induced liver disease (RILD) has been tracked when assessing the safety of fractionated liver radiotherapy. However, due to the rarity and severity of events, a more sensitive measure of liver damage is necessary. This study characterizes the time course of changes in generalizable measures of liver function as potential toxicity metrics. Methods: In this IRB-approved retrospective study, the records of 63 patients with 87 HCC tumors treated with SBRT at the University of Michigan between 2006 and 2012 were reviewed. Changes in Child-Pugh (CP), MELD, and MELD-Na were analyzed using the Student t test and chi-squared test. Results: 83% of the patients had cirrhosis, 62% hepatitis (hep) C, 7% hep B, 25% alcoholic, and 13% other. 83% had prior liver-directed therapy. 24% had >1 tumor concurrently treated with SBRT. Median tumor size was 2.3 cm (0.7-10), gross tumor volume was 9.2 cc (0.6-469), and mean liver dose-GTV was 4.4 Gy (0-17.6 Gy). Prior to SBRT, 73% were CP A, 25% CP B, and 2% CP C. Median baseline CP, MELD, and MELD-Na were 5, 9, and 10. Mean CP increases after 3, 6, 9, and 12 months were 0.84, 1.79, 1.72, and 1.33; increases in MELD 1.47, 2.88, 5.38, and 3.91; increases in MELD-Na 1.45, 2.03, 4.24, and 2.48. All changes were significantly increased from baseline. On univariate analysis, >1 tumor and cirrhosis predicted for a 1+ point increase in CP and >1 tumor and higher mean liver dose-GTV for a 2+ point increase in CP. Older age, >1 tumor, smaller GTV, and smaller max tumor dimension predicted for a 10+ point increase in MELD and >1 tumor, hep C cirrhosis, and higher baseline MELD-Na for MELD-Na. Patients treated concurrently to >1 tumor had greater increases in CP (3.60 vs. 0.81), MELD (9.33 vs. 1.97), and MELD-Na (8.47 vs. 2.19), p < 0.0001 for all, compared to those with 1 tumor. No differences were seen with gender, portal vein thrombosis, number of prior treatments and baseline Child-Pugh classifications. Conclusions: We describe a time course and predictive factors for change in CP, MELD, and MELD-Na scores after SBRT for HCCs. These should be investigated further for potential use in toxicity modeling after incorporating dosimetric parameters.

Natural history of T1N0M0 hepatocellular carcinoma: Large scale study in the United States.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 416-416
Author(s):  
Humaid Obaid Al-Shamsi ◽  
Reham Abdel-Wahab ◽  
Manal Hassan ◽  
Gehan Botrus ◽  
Ahmed S Shalaby ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systemic Therapy ◽  
Cox Regression ◽  
Univariate Analysis ◽  
The United States ◽  
Categorical Variables ◽  
Cancer Center ◽  
Female Ratio ◽  
Cox Regression Analysis ◽  
Hepatic Reserve

416 Background: Prognostic modeling of hepatocellular carcinoma (HCC) is complex due to preexisting cirrhosis in most cases. Tumor features and factors related to functional hepatic reserve must be taken into account when considering treatment options or counseling patients about their survival. The key prognostic factors may vary at different stages of the disease especially for early stage. Methods: From 1992 to 2011 total of 397 HCC patients with T1N0M0 were referred to MD Anderson Cancer Center for treatment. Detailed clinical-pathologic information were retrieved from medical records. Univariate analysis was done using the c2or Fisher’s exact test for categorical variables. Kaplan-Meier used to estimate the median overall survival (OS). Multivariate cox regression analysis was performed to estimate the hazard ratio (HR) and 95% confidence interval (CI). Results: The male to female ratio was3:1. The mean age ± standard deviation was 65.04 ± 12.5, 57.2% were non-viral related, 59.7% had cirrhosis, and 9.3% had poorly differentiated tumor (PDT). Median OS (95% CI) was 28.5 months (23.6 – 33.4). First line therapy is summarized in table 1. Surgical intervention was similar to systemic therapy with 76% reduction in mortality compared to non-treated group. Restricted analysis among cirrhotic patients showed similar results. PDT was associated with significant poor prognosis compared to well-differentiated tumor, HR (95% CI) was 2.42 (1.36-4.28) after adjustment for demographic, epidemiological, and clinical factors. Conclusions: Our results indicate that T1N0M0 HCC patients have similar outcome with systemic therapy and surgery which could be beneficial for patients with underlying cirrhosis and high risk of postsurgical complications. [Table: see text]

scholarly journals The Prognostic Correlation of Heart Rate Variability at Diagnosis with Survival of Patients with Hepatocellular Carcinoma

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 890
Author(s):  
Ana-Maria Ciurea ◽  
Dan Ionuț Gheonea ◽  
Michael Schenker ◽  
Alina Maria Mehedințeanu ◽  
Georgică Costinel Târtea ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Tumor Size ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Early Therapy ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Noninvasive Biomarker

Background: Heart rate variability (HRV) indices have been shown to be associated with prognosis in various types of cancer. This study aims to assess the ability of these indices to predict survival in hepatocellular carcinoma (HCC) patients after diagnosis. Methods: We retrospectively collected data from 231 patients diagnosed with HCC between January 2014 and March 2018. The baseline clinical-pathological variables and HRV indices (extracted from Holter electrocardiogram recordings) were analyzed. Results: Univariate and multivariate analyses were performed to identify the predictive value of the above factors for overall survival (OS). The univariate analysis revealed that an age > 60 years, hepatitis C, portal vein involvement (thrombosis), a tumor size > 5 cm, alpha-fetoprotein (AFP) > 400 ng/mL, serum albumin, and C-reactive protein (CRP) were risk factors for poor OS. Multivariable Cox regression analyses identified that a tumor size > 5 cm and AFP > 400 ng/mL predict poorer outcomes in HCC patients. It should be mentioned that, in both the univariate analysis and in the multivariate analysis, between HRV indices, SDNN (standard deviation of all normal-to-normal (NN) intervals) < 110 ms was an independent risk factor for OS with an HR of 3.646 (95% CI 2.143 to 6.205). Conclusion: This study demonstrates that HRV indices identify HCC patients at high risk of death and suggests that such monitoring might guide the need for early therapy in these types of patients, as well as the fact that HRV can be a potential noninvasive biomarker for HCC prognosis.

ALBI-RT: A novel radiation therapy specific hepatotoxicity prediction model for hepatocellular carcinoma patients.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 444-444
Author(s):  
Stephanie K Schaub ◽  
Stephen R. Bowen ◽  
Tobias Robert Chapman ◽  
Matthew J. Nyflot ◽  
Smith Apisarnthanarax
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiation Therapy ◽  
Relative Risk ◽  
Cox Regression ◽  
Continuous Variable ◽  
Data Sets ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Radiation Induced ◽  
Pre Treatment

444 Background: The albumin-bilirubin (ALBI) grade system was optimized to predict survival in hepatocellular carcinoma (HCC) patients; however, its applicability to patients treated with radiation therapy (RT) is unclear. We propose a novel analysis of the ALBI equation, designated ALBI-RT, to assess hepatotoxicity risk after RT. Methods: We retrospectively reviewed 48 consecutive HCC patients treated with RT (2013-2016). Raw ALBI values and Child-Pugh (CP) scores were calculated. Any patient deaths were examined for radiation induced liver disease (RILD). Raw ALBI was assessed as a continuous variable to perform ROC analyses to identify cutoffs for overall survival (OS) and RILD-specific survival (RILD-SS). Univariate predictors of OS and RILD-SS were evaluated using Cox regression to determine hazard ratios (HR). Results: Patient cohort was comprised of 60% CP-A and 39% CP-B/C. Median follow-up and OS was 13 and 10 months, respectively. There were 18 deaths with 6 ascribed to RILD. We identified a raw ALBI cutoff at -1.70 (AUC = 0.94, p = 0.008) that was predictive of RILD-SS with a sensitivity of 100% and specificity of 71%. Dichotimization of RILD-SS cutoff generated two ALBI-RT risk categories: low-risk A < -1.70 (n = 29) and high-risk B ≥ -1.70 (n = 18). ALBI-RT subdivided CP-A patients, identifying 14% at increased risk of RILD; conversely, ALBI-RT grade A identified 21% of CP-B/C patients at a decreased risk of RILD. For OS, raw ALBI as a continuous variable (HR 3.0, p = 0.02), and to a lesser degree ALBI-RT Grade B (HR 2.4, p = 0.06), performed similarly to traditional ALBI grade (HR 3.0, p = 0.01), and CP score (HR 1.4, p = 0.03). In contrast for RILD-SS, raw ALBI as a continuous variable (HR 25.1, p = 0.01) and ALBI-RT Grade B (HR 9.9, p = 0.04) were associated with an elevated relative risk of RILD than traditional ALBI grade (HR 5.8, p = 0.02) and CP score (HR 2.3, p = 0.003). Conclusions: ALBI-RT is a promising metric for pre-treatment assessment of HCC patients for predicting RILD-related death after RT with an elevated relative-risk compared to both CP and conventional ALBI grades. Future prospective evaluation and validation in independent data sets will strengthen the generalizability and utility of ALBI-RT.

scholarly journals Prognostic significance of pre-treatment ALBI grade in advanced non-small cell lung cancer receiving immune checkpoint therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ryosuke Matsukane ◽  
Hiroyuki Watanabe ◽  
Kojiro Hata ◽  
Kimitaka Suetsugu ◽  
Toshikazu Tsuji ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Propensity Score ◽  
Liver Function ◽  
Small Cell Lung Cancer ◽  
Immune Checkpoint ◽  
Hepatic Function ◽  
Small Cell ◽  
Small Cell Lung ◽  
Hepatic Reserve ◽  
Pre Treatment

AbstractThe liver is an essential organ for regulating innate and acquired immunity. We hypothesized that the pre-treatment hepatic function affects the clinical outcome of immune checkpoint inhibitors (ICIs) in non-small cell lung cancer (NSCLC). We analyzed 140 patients with NSCLC who received ICIs. We investigated the association between pre-treatment liver function, assessed using the albumin–bilirubin (ALBI) grade, and clinical outcomes in univariate, multivariate, and propensity score matching analyses. Patients were divided into four grades according to pre-treatment liver function. Eighty-eight patients had good hepatic reserve (ALBI grade 1 or 2a), whereas 52 patients had poor hepatic reserve (ALBI grade 2b or 3). In the univariate Kaplan–Meier analysis, the ALBI grade 1, 2a group had a significantly prolonged progression-free survival (PFS, 5.3 versus 2.5 months, p = 0.0019) and overall survival (OS, 19.6 vs. 6.2 months, p = 0.0002). These results were consistent, regardless of whether the analysis was performed in patients with a performance status of 0 or 1 at pre-treatment (N = 124) or in those selected using propensity score matching (N = 76). In the multivariate analysis, pre-treatment ALBI grade was an independent prognostic factor for both PFS (hazard ratio [HR] 0.57, 95% confidence interval [95% CI] 0.38–0.86, p = 0.007) and OS (HR 0.45, 95% CI 0.29–0.72, p = 0.001). Our results suggest that pre-treatment hepatic function assessed by ALBI grade could be an essential biomarker for predicting the efficacy of treatment with ICIs in NSCLC.

scholarly journals Construction and Validation of a Prognostic Risk Model Based on Autophagy-Related Genes in Hepatocellular Carcinoma Cells

2021 ◽  
Author(s):  
Rui Feng ◽  
Jian Li ◽  
Weiling Xuan ◽  
Hanbo Liu ◽  
Dexin Cheng ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Regression Analysis ◽  
Differential Expression ◽  
Prognostic Model ◽  
Risk Model ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Differential Expression Analysis ◽  
Cox Regression Analysis ◽  
Dismal Prognosis

Abstract Background Hepatocellular carcinoma (HCC) is a prevalent primary liver cancer and the main cause of cancer mortality. Its high complexity and dismal prognosis bring dramatic difficulty to treatment. Due to the disclosed dual functions of autophagy in cancer development, understanding autophagy-related genes devotes into seeking novel biomarkers for HCC. Methods Differential expression of genes in normal and tumor groups was analyzed to acquire autophagy-related genes in HCC. GO and KEGG pathway analyses were conducted on these genes. Genes were then screened by univariate regression analysis. The screened genes were subjected to multivariate Cox regression analysis to build a prognostic model. The model was validated by ICGC validation set. Results Altogether, 42 autophagy-related differential genes were screened by differential expression analysis. Enrichment analysis showed that they were mainly enriched in pathways including regulation of autophagy and cell apoptosis. Genes were screened by univariate analysis and multivariate Cox regression analysis to build a prognostic model. The model was constituted by 6 feature genes: EIF2S1, BIRC5, SQSTM1, ATG7, HDAC1, FKBP1A. Validation confirmed the accuracy and independence of this model in predicting HCC patient’s prognosis. Conclusion A total of 6 feature genes were identified to build a prognostic risk model. This model is conducive to investigating interplay between autophagy-related genes and HCC prognosis.

Risk Factors for Hepatocellular Carcinoma After Splenectomy in Liver Cirrhotic Patients

2021 ◽  
pp. 000313482110415
Author(s):  
Naruhiko Honmyo ◽  
Tsuyoshi Kobayashi ◽  
Shintaro Kuroda ◽  
Kentaro Ide ◽  
Masahiro Ohira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Portal Hypertension ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Hemoglobin Level ◽  
Rank Test ◽  
Predictive Index ◽  
Preoperative Hemoglobin ◽  
Preoperative Hemoglobin Level

Background Splenectomy is sometimes indicated for portal hypertension caused by cirrhosis, which is a risk for hepatic carcinogenesis. This study aimed to identify risk factors for hepatocellular carcinoma (HCC) development after splenectomy. Methods This retrospective study included 65 patients who underwent splenectomy for portal hypertension between 2009 and 2017. Cox regression analyses were performed to identify factors related to HCC development after splenectomy. The predictive index for HCC development was constructed from the results of multivariate analysis, and 3 risk-dependent groups were defined. Discrimination among the groups was estimated using Kaplan-Meier curves and the log-rank test. Results Post-splenectomy, 36.9% of patients developed HCC. In the univariate analysis, the etiology of cirrhosis (hepatitis C virus antibody, P = .005, and hepatitis B surface antigen, P = .008, referring to non-B and non-C patients, respectively), presence of HCC history ( P < .001), and preoperative hemoglobin level ( P = .007) were related to HCC development, and the presence of HCC history ( P = .002) and preoperative hemoglobin level ( P = .022) were independent risk factors. The predictive index classified three groups at risk; the hazards in each group were significantly different (low vs middle risk, P = .035, and middle vs high risk, P = .011). Discussion The etiology of cirrhosis, presence of HCC history, and hemoglobin level were associated with HCC development after splenectomy. The predictive model may aid in HCC surveillance after splenectomy for patients with portal hypertension.

scholarly journals Prediction of Microvascular Invasion in Hepatocellular Carcinoma: Preoperative Gd-EOB-DTPA-Dynamic Enhanced MRI and Histopathological Correlation

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Mengqi Huang ◽  
Bing Liao ◽  
Ping Xu ◽  
Huasong Cai ◽  
Kun Huang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Prediction Model ◽  
Tumor Size ◽  
Univariate Analysis ◽  
Microvascular Invasion ◽  
Arterial Phase ◽  
Hepatobiliary Phase ◽  
Imaging Features ◽  
Tumor Margin ◽  
Enhanced Mri

Objective. To investigate the imaging features observed in preoperative Gd-EOB-DTPA-dynamic enhanced MRI and correlated with the presence of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients. Methods. 66 HCCs in 60 patients with preoperative Gd-EOB-DTPA-dynamic enhanced MRI were retrospectively analyzed. Features including tumor size, signal homogeneity, tumor capsule, tumor margin, peritumor enhancement during mid-arterial phase, peritumor hypointensity during hepatobiliary phase, signal intensity ratio on DWI and apparent diffusion coefficients (ADC), T1 relaxation times, and the reduction rate between pre- and postcontrast enhancement images were assessed. Correlation between these features and histopathological presence of MVI was analyzed to establish a prediction model. Results. Histopathology confirmed that MVI were observed in 17 of 66 HCCs. Univariate analysis showed tumor size (p=0.003), margin (p=0.013), peritumor enhancement (p=0.001), and hypointensity during hepatobiliary phase (p=0.004) were associated with MVI. A multiple logistic regression model was established, which showed tumor size, margin, and peritumor enhancement were combined predictors for the presence of MVI (α=0.1). R2 of this prediction model was 0.353, and the sensitivity and specificity were 52.9% and 93.0%, respectively. Conclusion. Large tumor size, irregular tumor margin, and peritumor enhancement in preoperative Gd-EOB-DTPA-dynamic enhanced MRI can predict the presence of MVI in HCC.

scholarly journals Changes in Background Liver Function in Patients with Hepatocellular Carcinoma over 30 Years: Comparison of Child-Pugh Classification and Albumin Bilirubin Grade

Liver Cancer ◽  
2020 ◽  
Vol 9 (5) ◽  
pp. 518-528 ◽  
Author(s):  
Takashi Kumada ◽  
Hidenori Toyoda ◽  
Toshifumi Tada ◽  
Satoshi Yasuda ◽  
Junko Tanaka
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Function ◽  
Hepatic Function ◽  
Hepatic Reserve ◽  
Significant Survival ◽  
Detailed Evaluation ◽  
Group A ◽  
Group B ◽  
Survival Differences ◽  
Group D

Background: Background liver function in patients with hepatocellular carcinoma (HCC) has improved remarkably with advances in various treatments. Recently, the Child-Pugh classification (CPC) system has been recognized as limited in its ability to assess patients with good hepatic reserve. We compared the albumin-bilirubin (ALBI) grade, which is suitable for a more detailed evaluation of patients with good liver function, with CPC over a 30-year period. Methods: A total of 2,347 patients were analyzed. Patients were stratified by year of diagnosis into 6 groups: Group A (1990–1994, n = 376), Group B (1995–1999, n = 434), Group C (2000–2004, n = 438), Group D (2005–2009, n = 444), Group E (2010–2014, n = 392), and Group F (2015–2018, n = 263). We compared ALBI grade and CPC across the groups. Results: The prevalence of patients with CPC A at diagnosis increased throughout the study period, reaching nearly 80% in Groups E and F (p < 0.001). By contrast, the percentage of patients with ALBI grade 1 disease remained approximately 50% in Groups E and F (p < 0.001). Modified ALBI (mALBI) grade 2a corresponds to patients with CPC A who have poor hepatic function. There were significant survival differences between patients with mALBI grade 1 versus 2a, 1 versus 2b, and 2a versus 2b disease, respectively (p < 0.0001), in patients with CPC A. Conclusions: CPC is not suitable for assessing patients with recently diagnosed HCC and good remnant hepatic function. In such patients with HCC, the prognosis can be stratified by ALBI grade rather than CPC.

scholarly journals Conventional versus drug-eluting beads chemoembolization for infiltrative hepatocellular carcinoma: a comparison of efficacy and safety

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Zi-shu Zhang ◽  
Hui-zhou Li ◽  
Cong Ma ◽  
Yu-dong Xiao
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Size ◽  
Tumor Response ◽  
Liver Toxicity ◽  
Objective Response ◽  
Efficacy And Safety ◽  
Tace Group ◽  
Drug Eluting Beads ◽  
Drug Eluting ◽  
The Difference

Abstract Background To compare the efficacy and safety between conventional transarterial chemoembolization (cTACE) and drug-eluting beads TACE (DEB-TACE) in patients with infiltrative hepatocellular carcinoma (iHCC). Methods A total of 89 iHCC patients who were treated with either cTACE (n = 33) or DEB-TACE (n = 56) between April 2013 and September 2017 were included in this retrospective study. Patients with the situations that might have a poor outcome were defined as advanced disease including Child-Pugh class B, bilobar lesions, tumor size greater than 10 cm, ECOG 1–2, tumor burden of 50–70%, and the presence of ascites, arterioportal shunt (APS), and portal venous tumor thrombus (PVTT). The tumor response was measured 1-month and 3-month after the procedure. Progression-free survival (PFS) was calculated. Toxicity was graded by Common Terminology Criteria for Adverse Events v5.0 (CTCAE v5.0). The differences in tumor response, PFS, and toxicity were compared between the DEB-TACE group and cTACE group. Results At 1-month and 3-month after the procedure, the objective response rate (ORR) in the overall study population was similar in DEB-TACE group and cTACE group. The disease control rate (DCR), at 1-month after the procedure, was significantly higher in the patients treated with DEB-TACE relative to those treated with cTACE (P = 0.034), while after 3 months, the difference did not differ between two groups. DEB-TACE showed a higher DCR than cTACE in patients with tumor size greater than 10 cm (P = 0.036) or associated with APS (P = 0.030) at 1-month after the procedure, while after 3 months, the difference was only noted in patients with APS (P = 0.036). The median PFS in DEB-TACE group was 96 days, while in cTACE group was 94 days, and there was no difference in PFS between two groups (P = 0.831). In the side effect analysis, abdominal pain (P = 0.034) and fever (P = 0.009) were more frequently present in the cTACE group than DEB-TACE group, but there was no difference in high grade liver toxicity between the two groups. Conclusions Compared to cTACE, DEB-TACE offers slightly better DCR and tolerability for iHCC patients, particularly in patients associated with APS and large tumor size. However, DEB-TACE does not provide higher PFS than cTACE.

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