Efficacy and safety of transhepatic arterial chemoembolization with drug-loaded microspheres in unresectable primary liver cancer

BACKGROUND Transhepatic arterial chemoembolization(TACE),as a local treatment,has been widely used in the treatment of unresectable liver cancer.The introduction of drug carrier microspheres has brought new hope for the therapeutic effect of TACE.Microspheres can realize the slow release and directional delivery of drugs,reduce systemic toxicity and improve local curative effect.AIM To compare the effectiveness of traditional transcatheter arterial chemoembolization against microsphere-assisted transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma that is incurable.METHODS We searched the PubMed,Embase,Cochrane Library,and CNKI databases for clinical trials of drug-luting beads TACE(DEB-TACE)vs conventional TACE(cTACE)for the treatment of unresectable liver cancer.We screened references based on inclusion and exclusion criteria and then selected valid data for meta-analysis using RevMan 53 software.The complete response(CR)rate,partial response(PR)rate,postoperative stable disease(SD)rate,and 6-month and 12-month survival rates were compared.RESULTS A total of 12 articles were included,including 1177 patients,519 of whom received DEB-TACE and 658 of whom received cTACE.The CR rate in the DEB-TACE group was much greater than that in the cTACE group[relative risk(RR)=1.42,95%CI:1.18-1.72,P=0.0002].The 12-month survival rate significantly increased(RR=1.09;95%CI:1.01-1.17,P=0.03);the PR rate(RR=1.13;95%CI:0.97-1.30,P=0.12);the SD rate(RR=0.82;95%CI:0.64-1.05,P=0.12);and the 6-month survival rate(RR=1.05;95%CI:1.00-1.10,P=0.07).There was no significant difference(P<0.05).CONCLUSION Compared with those of iodized oil TACE,the drug-loaded microspheres tended to have therapeutic advantages.

Impact of hepatectomy and postoperative adjuvant transarterial chemoembolization on serum tumor markers and prognosis in intermediate-stage hepatocellular carcinoma

BACKGROUND Primary hepatocellular carcinoma(HCC)is a common malignant tumour,and its early symptoms are often not obvious,resulting in many patients experiencing middle-to late-stage disease at the time of diagnosis.The optimal time for surgery is often missed for these patients,and those who do undergo surgery have unsatisfactory long-term outcomes and a high recurrence rate within five years.Therefore,postoperative follow-up treatments,such as transhepatic arterial chemoembolization(TACE),have become critical to improving survival and reducing recurrence rates.AIM To validate the prophylactic role of TACE after hepatic resection and to assess its impact on patient prognosis.METHODS This study investigated the efficacy of TACE in patients with intermediate-stage HCC after hepatectomy.When the post-treatment results of the observation group and the control group were compared,it was found that the inclusion of TACE significantly improved the clinical efficacy,reduced the levels of tumour markers and did not aggravate the damage to liver function.Thus,this may be an effective and comprehensive treatment strategy for patients with intermediate-stage HCC that helps to improve their quality of life and survival time.RESULTS When the baseline data were analysed,no statistical differences were found between the two groups in terms of gender,age,hepatitis B virus,cirrhosis,Child-Pugh grading,number of tumours,maximum tumour diameter and degree of tumour differentiation.The assessment of clinical efficacy showed that the post-treatment overall remission rate of the observation group was significantly higher than that of the control group.In terms of changes in tumour markers,the alpha-fetoprotein and carcinoembryonic antigen levels in the patients in the observation group decreased more significantly after treatment compared with those in the control group.When post-treatment changes in liver function indicators were analysed,no statistical differences were found in the total bilirubin,alanine aminotransferase and aspartate aminotransferase levels between the two groups.CONCLUSION In patients with intermediate-stage HCC,post-hepatectomy TACE significantly improved clinical outcomes,reduced tumour-marker levels and may have improved the prognosis by removing residual lesions.Thus,this may be an effective and comprehensive treatment strategy for patients with intermediate-stage HCC.

Portal vein tumor thrombus is a bottleneck in the treatment of hepatocellular carcinoma

The effect of portal vein tumor thrombus(PVTT) on the prognosis of patients with hepatocellular carcinoma has become clear over the past several decades. However, identifying the mechanisms and performing the diagnosis and treatment of PVTT remain challenging. Therefore, this study aimed to summarize the progress in these areas. A computerized literature search in Medline and EMBASE was performed with the following combinations of search terms: "hepatocellular carcinoma" AND "portal vein tumor thrombus." Although several signal transduction or molecular pathways related to PVTT have been identified, the exact mechanisms of PVTT are still largely unknown. Many biomarkers have been reported to detect microvascular invasion, but none have proved to be clinically useful because of their low accuracy rates. Sorafenib is the only recommended therapeutic strategy in Western countries. However, more treatment options are recommended in Eastern countries, including surgery, radiotherapy(RT), transhepatic arterial chemoembolization(TACE), transarterial radioembolization(TARE), and sorafenib. Therefore, we established a staging system based on the extent of portal vein invasion. Our staging system effectively predicts the long-term survival of PVTT patients. Currently, several clinical trials had shown that surgery is effective and safe in some PVTT patients. RT,TARE, and TACE can also be performed safely in patients with good liver function. However, only a few comparative clinical trials had compared the effectiveness of these treatments. Therefore, more randomized controlled trials examining the extent of PVTT should be conducted in the future.