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. 2023 Nov 1;109(11):3303-3311.
doi: 10.1097/JS9.0000000000000654.

Hepatic arterial infusion chemotherapy versus transarterial chemoembolization, potential conversion therapies for single huge hepatocellular carcinoma: a retrospective comparison study

Min Deng  1   2   3 , Hao Cai  4 , Benyi He  1   2 , Renguo Guan  1   2 , Carol Lee  5 , Rongping Guo  1   2
Affiliations

Hepatic arterial infusion chemotherapy versus transarterial chemoembolization, potential conversion therapies for single huge hepatocellular carcinoma: a retrospective comparison study

Min Deng et al. Int J Surg. .

Abstract

Background: The treatment efficacy of transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC) for huge single hepatocellular carcinoma (HCC) has not been fully documented. The aim of this study was to compare TACE and HAIC for patients with solitary nodular HCCs greater than or equal to 10 cm without vascular invasion and metastasis.

Methods: From July 2015 to June 2020, a total of 147 patients with single nodular HCC greater than or equal to 10 cm without vascular invasion and metastasis receiving TACE ( n =77) or HAIC ( n =70) were retrospectively enrolled. The tumor response, overall survival (OS), and progression-free survival (PFS) were investigated and compared. The treatment outcome of two transarterial interventional therapies was explored.

Results: The objective response rate and PFS were higher in patients who received HAIC than in those who received TACE (44.3 vs. 10.4% and 8.9 vs. 4.2 months, respectively; P =0.001 and P =0.030), whereas the disease control rate and OS were not significantly different (92.9 vs. 84.4% and 21.3 vs. 26.6 months, respectively; P =0.798 and P =0.749). The decreased levels of alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II (PIVKA-II) in patients treated with HAIC were significantly higher than those treated with TACE ( P =0.038 and P <0.001). Multivariable analysis showed that the aspartate aminotransferase/platelet ratio index was associated with OS, whereas albumin-bilirubin grade and PIVKA-II were associated with PFS.

Conclusions: HAIC has better potential than TACE to control local tumors for huge single HCC without vascular invasion and metastasis and thus may be the preferred conversion therapy for these tumors.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Flow diagram summarising the patient enrollment process of this study. HCC, hepatocellular carcinoma; ECOG PS, Eastern Cooperative Oncology Group Performance Status; TACE, transarterial chemoembolization; HAIC, hepatic arterial infusion chemotherapy.
Figure 2
Figure 2
Tumor response evaluation based on the mRECIST in patients receiving TACE and HAIC. mRECIST, modified Response Evaluation Criteria in Solid Tumors; HAIC, hepatic arterial infusion chemotherapy; TACE, transarterial chemoembolization.
Figure 3
Figure 3
Patient survival was shown by the Kaplan–Meier curves. The OS (A) and PFS (B) in patients with tumor response (CR/PR vs SD/PD) according to mRECIST criteria. The OS (C) and PFS (D) in patients treated with HAIC versus TACE. OS, overall survival; PFS, progression-free survival; mRECIST, modified Response Evaluation Criteria in Solid Tumors; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease; HAIC, hepatic arterial infusion chemotherapy; TACE, transarterial chemoembolization.
See this image and copyright information in PMC

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