Advanced-stage hepatocellular carcinoma with portal vein thrombosis: conventional versus drug-eluting beads transcatheter arterial chemoembolization

Abstract

Objectives: Our study sought to compare the overall survival in patients with hepatocellular carcinoma (HCC) and portal venous thrombosis (PVT), treated with either conventional trans-arterial chemoembolization (cTACE) or drug-eluting beads (DEB) TACE.

Methods: This retrospective analysis included a total of 133 patients, treated without cross-over and compared head-to-head by means or propensity score weighting. Mortality was compared using survival analysis upon propensity score weighting. Adverse events and liver toxicity grade ≥3 were recorded and reported for each TACE. In order to compare with historical sorafenib studies, a sub-group analysis was performed and included patients who fulfilled the SHARP inclusion criteria.

Results: The median overall survival (MOS) of the entire cohort was 4.53 months (95 % CI, 3.63-6.03). MOS was similar across treatment arms, no significant difference between cTACE (N = 95) and DEB-TACE (N = 38) was observed (MOS of 5.0 vs. 3.33 months, respectively; p = 0.157). The most common adverse events after cTACE and DEB- TACE, respectively, were as follows: post-embolization syndrome [N = 57 (30.0 %) and N = 38 (61.3 %)], diarrhea [N = 3 (1.6 %) and N = 3 (4.8 %)], and encephalopathy [N = 11 (5.8 %) and N = 2 (3.2 %)].

Conclusion: Our retrospective study could not reveal a difference in toxicity and efficiency between cTACE and DEB-TACE for treatment of advanced stage HCC with PVT.

Key points: • Conventional TACE (cTACE) and drug-eluting-beads TACE (DEB-TACE) demonstrated equal safety profiles. • Survival rates after TACE are similar to patients treated with sorafenib. • Child-Pugh class and tumor burden are reliable predictors of survival.

Keywords: Adverse effects; Chemoembolization; Hepatocellular carcinoma; Liver; Propensity score.

Fig. 1

Inclusion criteria flowchart. PVT, portal venous thrombosis; cTACE, conventional transarterial chemoembolization; DEB-TACE, drug-eluting beads TACE

Fig. 2

Kaplan-Meier curves demonstrating survival after propensity score weighting. The propensity score model has used the covariates defined by BCLC. Survival was defined as the time from the date of TACE to the date of death from any cause. Patients who were lost to follow-up or received another therapy (such as liver transplantation or sorafenib) were censored. BCLC, Barcelona Clinic Liver Cancer; cTACE, conventional transarterial chemoembolization; DEB-TACE, drug-eluting beads TACE

Fig. 3

Survival comparison of cTACE and DEB-TACE according to the SHARP inclusion criteria [9]. Survival sub-analysis with characteristics from the SHARP trial [9] and the Asia-Pacific trial [19] (BCLC C, ECOG PS ≤ 2 and Child-Pugh class A; [SHARP criteria]). SHARP, Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol; cTACE, conventional trans-arterial chemoembolization; DEB-TACE, drug-eluting beads TACE