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. 2022 Nov 30;22(1):1242.
doi: 10.1186/s12885-022-10361-5.

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

Junwei Chen #  1 , Lisha Lai #  2 , Junyang Luo  1 , Haofan Wang  1 , Mingan Li  1 , Mingsheng Huang  3
Affiliations

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

Junwei Chen et al. BMC Cancer. .

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.

PubMed Disclaimer

Conflict of interest statement

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
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
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
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
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
See this image and copyright information in PMC

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