DEM-TACE as the initial treatment could improve the clinical efficacy of the hepatocellular carcinoma with portal vein tumor thrombus: a retrospective controlled study

Abstract

Background: Conventional-transarterial chemoembolization (C-TACE) was proven to improve overall survival (OS) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT), drug-eluting microsphere-TACE (DEM-TACE) was supposed to provide more benefit than C-TACE in this respect.

Purpose: To compare the safety and efficacy between DEM-TACE and C-TACE as the initial treatment in HCC patients with PVTT and to identify prognostic factors of OS.

Methods: The medical records of advanced HCC patients with PVTT who underwent DEM-TACE or C-TACE as the initial thearpy from September 2015 with mean follow-up time 14.9 ± 1.2 (95% CI 12.6-17.2) months were retrospectively evaluated. A total of 97 patients were included, 49 patients in the DEM-TACE group and 48 in the C-TACE group. Adverse events (AEs) related to TACE were compared. Tumor and PVTT radiologic response, time to tumor progression (TTP) and OS were calculated and compared in both groups.

Results: Patients in DEM-TACE group had a better radiologic response (Tumr response: 89.8% vs. 75.0%; PVTT response: 85.7% vs. 70.8%; overall response: 79.6% vs. 58.3%, P = 0.024) and longer TTP (7.0 months vs. 4.0 months, P = 0.040) than patients in C-TACE group. A lower incidence of abdominal pain was found in the DEM-TACE group than in C-TACE group (21 vs. 31, P = 0.032), but there were no significant differences between DEM-TACE and C-TACE patients in any other AEs reported. When compared to C-TACE, DEM-TACE also showed significant OS benefits (12.0 months vs. 9.0 months, P = 0.027). DEM-TACE treatment, the absence of arterioportal shunt (APS), lower AFP value and better PVTT radiologic response were the independent prognostic factors for OS in univariate/multivariate analyses, which provided us with a guide for better patient selection.

Conclusions: Based on our retrospective study, DEM-TACE can be performed safely and might be superior to C-TACE as the initial treatment for HCC patients with PVTT.

Trial registration: Retrospectively registered.

Keywords: Drug-eluting microsphere; Hepatocellular carcinoma; Portal vein tumor thrombosis; Transarterial chemoembolization.

Fig. 1

Flow diagram shows exclusion criteria. HCC: hepatocellular carcinoma; PVTT: portal vein tumor thrombus; DEM-TACE: Drug Eluting Microsphere-TACE; C-TACE: Conventional-TACE; HAIC: hepatic arterial infusion chemotherapy

Fig. 2

a. 66 years old, female patients, contrast enhanced CT cross sectional image demonstrating a HCC lesion in segment 6 and PVTT in the second order portal vein. b. the initial DEM-TACE angiogram demonstrate the feeding artery of tumor and PVTT. c. Contrast enhanced MRI 1 months after the initial DEM-TACE demonstrate the residual tumor. d. second DEM-TACE angiogram demonstrating the residual tumor. e. CT images acquired 1 months after the second DEM-TACE demonstrate no viable tumour and PVTT (radiologic response: CR). f. MRI images acquired more than 26 months after the second DEM-TACE demonstrate that the disappearance of PVTT and the patent portal vein

Fig. 3

a. OS Comparison for DEM-TACE and C-TACE. b. TTP Comparison for DEM-TACE and C-TACE. OS: Overall Survival; TTP: Time to Tumor Progression

Fig. 4

Subgroup analysis of OS: a,b: presence/absence of APS; c,d: AFP < 400 ng/ml and AFP ≥ 400 ng/ml; e,f: PVTT without progressive response/with progressive response. APS: arterioportal shunt; AFP: alpha-fetoprotein; DEM-TACE: drug-eluting microsphere-transarterial chemoembolization; C-TACE: conventional-transarterial chemoembolization; PVTT: portal vein tumor thrombus; CR: Complete Response; PD: Progressive Disease