Value of selective chemoembolization in treatment of hepatic metastases in colorectal carcinoma

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Study on the Changes in Microvessel Density in Hepatocellular Carcinoma Following Transcatheter Arterial Chemoembolization

To study the changes in intratumoral microvessel density (MVD) in hepatocellular carcinoma (HCC) following transcatheter arterial chemoembolization (TACE), MVD in 42 HCC specimens histologically verified was studied by using immunohistochemical method. Of all the specimens, 20 were obtained from the patients treated with surgical resection alone, 22 from those with second stage surgical resection after TACE. The results showed that the MVD in HCC tissues was 53.4±21 9 in the TACE group and 27.6±9.2 in the single operating group, respectively, with the difference being significant between them ( P <0.001). It was suggested that TACE might contribute to angiogenesis of HCC, possibly due to anoxic stress and ischemia reperfusion injury.

Transarterial chemoembolization with pirarubicin-eluting microspheres in patients with unresectable hepatocellular carcinoma: Preliminary results

Purpose:To present the early results of pirarubicin-eluting microsphere transarterial chemoembolization(PETACE)for patients with unresectable hepatocellular carcinoma(HCC).Materials and methods:We retrospectively analyzed 55 consecutive patients with HCC who received PE-TACE between April 1,2015 and August 30,2016.The complication rate,tumor response rate,progression-free survival(PFS),and overall survival(OS)were analyzed.Results:Adverse events were generally mild and included abdominal pain and fever,although a major complication was reported in 1 patient(1.8%).During a median follow-up of 10.0 months(range,3.0-24.0 months),14 patients(25.5%)achieved a complete tumor response,25(45.5%)had a partial response,9(16.4%)showed stable disease,and 7(12.7%)had disease progression.The 1-month overall response rate was 70.9%,and the local tumor response rate was 89.0%.The 1-month tumor response rate was 100%for Barcelona Clinic Liver Cancer(BCLC)stage A or B disease and 62.8%for BCLC stage C disease.The median PFS was 6.1 months(95%confidence interval[95%CI],3.4-8.8 months;range,1.0-24.0 months).The median OS was 11.0 months(95%CI,7.1-14.9 months;range,2.0-24.0 months).Kaplan-Meier analysis(log-rank test)found significant differences in OS between patients grouped by tumor number(P=0.006),tumor size(P=0.035),and Eastern Cooperative Oncology Group(ECOG)score(P=0.005).The tumor number(1 vs.>2)was the only factor independently associated with OS(hazard ratio[HR],2.867;95%CI,1.330-6.181;P=0.007).Conclusions:PE-TACE for unresectable HCC may be safe,with favorable tumor response rates and survival time,especially in patients with a single large tumor.Longer follow-up using a larger series is necessary to confirm these preliminary results.

Influence of preoperative transcatheter arterial chemoembolization on liver resection in patients with resectable hepatocellular carcinoma

Objective: To assess the influence of preoperative transcatheter arterial chemoembolization (TACE) on liver resection in patients with resectable hepato- cellular carcinoma (HCC). Methods: Of 126 patients with resectable HCC, 62 received preoperative TACE (TACE group) and the remaining 64 patients were selected as controls (non- TACE group). Perioperative risk factors including liver function alteration, mean blood loss during op- eration, mean time of clamping the porta hepatis, length of operation, postoperative abdominal drain- age at day 1, 2 and 3, morbidity and mortality were compared between the two groups. Results: Neither significant difference in liver func- tion alteration nor mortality was observed between the two groups. More severe hepatic cirrhosis, lon- ger operation time, more blood loss and postopera- tive abdominal drainage were noted in the TACE group than in the non-TACE group. There was no significant difference in postoperative morbidity be- tween the two groups. Conclusions: Preoperative TACE for resectable HCC increases surgical difficulty and risk, and therefore should be considered prudently according to the indi- viduality of patients.

Arterial chemoembolization for hepatocellular carcinoma

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Transarterial Chemoembolization Combined with Apatinib for Treatment of Advanced Hepatocellular Carcinoma:Analysis of Survival and Prognostic Factors

Objective Apatinib is a novel inhibitor of vascular endothelial growth factor receptor-2.The goal of this study was to evaluate overall survival(OS)after a combination of transarterial chemoembolization(TACE)and apatinib in patients with advanced hepatocellular carcinoma(HCC)and to identify the factors affecting patient survival.Methods Fifty-one patients with advanced HCC who received TACE in combination with apatinib in our hospital from June 2015 to May 2017 were enrolled.The OS and progression-free survival(PFS)were calculated using the Kaplan-Meier method.The log-rank test and Cox regression model were used to determine the factors affecting OS.Results The median OS and PFS of the patients were 15 months and 10 months,respectively.The 1-,2-,and 3-year survival rates were 64.7%,23.5%,and 1.8%,respectively.Univariate survival analysis showed that patients with Child-Pugh A(P=0.006),reduction rate of proper hepatic artery(P=0.016),hand-foot syndrome(P=0.005),secondary hypertension(P=0.050),and without ascites(P=0.010)had a better OS.Multivariate analysis showed that hand-foot syndrome(P=0.014),secondary hypertension(P=0.017),and reduction rate of proper hepatic artery(P=0.025)were independent predictors of better OS.Conclusion TACE combined with apatinib is a promising treatment for advanced HCC.Hand-foot syndrome,secondary hypertension,and the reduction rate of proper hepatic artery were associated with a better OS.

Transarterial chemoembolization in Barcelona Clinic Liver Cancer Stage 0/A hepatocellular carcinoma

AIM:To evaluate the clinical characteristics of patients with Barcelona Clinic Liver Cancer(BCLC)stage 0 and A hepatocellular carcinoma(HCC)after transarterial chemoembolization(TACE).METHODS:Between January 2001 and September2011,129 patients with BCLC stage 0 and stage A HCC who underwent TACE were retrospectively enrolled.Patient characteristics,routine computed tomography and TACE findings,survival time and 1-,5-,and 10-year survival rates,risk factors for mortality,and survival rates according to the number of risk factors were assessed.RESULTS:The mean size of HCC tumors was 2.4±1.1 cm,and the mean number of TACE procedures performed was 2.5±2.1.The mean overall survival time and 1-,5-,and 10-year survival rates were 80.6±4.9 mo and 91%,63%and 49%,respectively.In the Cox regression analysis,a Child-Pugh score>5(P=0.005,OR=3.86),presence of arterio-venous shunt(P=0.032,OR=4.41),amount of lipiodol used(>7 mL;P=0.013,OR=3.51),and female gender(P=0.008,OR=3.47)were risk factors for mortality.The 1-,5-,and 10-year survival rates according to the number of risk factors present were 96%,87%and 87%(no risk factors),89%,65%,and 35%(1 risk factor),96%,48%and unavailable(2 risk factors),and 63%,17%,and 0%(3 risk factors),respectively(P<0.001).CONCLUSION:TACE may be used as curative-intent therapy in patients with BCLC stage 0 and stage A HCC.The Child-Pugh score,arterio-venous shunt,amount of lipiodol used,and gender were related to mortality after TACE.

Tumor lysis syndrome after transarterial chemoembolization of hepatocellular carcinoma: Case reports and literature review

Tumor lysis syndrome (TLS) is a potentially lethal complication in cancer therapy. It may occur in highly sensitive tumors, especially in childhood cancer and leukemia, whereas, it is rare in the treatment of solid tumors in adults. TLS results from a sudden and rapid release of nuclear and cytoplasmic degradation products of malignant cells. The release of these can lead to severe alterations in the metabolic prof ile. Here, we present two cases of large hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE) that resulted in TLS. Although TLS rarely happens in the treatment of adult hepatic tumor, only a few cases have been reported. We should keep in mind that all patients with HCC, particularly those with large and rapidly growing tumors, must be closely watched for evidence of TLS after TACE.

Molecular targeting agents associated with transarterial chemoembolization or radiofrequency ablation in hepatocarcinoma treatment

Hepatocellular carcinoma(HCC)is the fifth most common cause of cancer in the world.According to Barcelona Clinic Liver Cancer modified criteria,patients with early stage disease are candidate to radiofrequency ablation(RFA),while patients with intermediate stage HCC are usually treated by transarterial chemoembolization(TACE).TACE and RFA induce a transient devascularisation effect followed by strong neoangiogenic stimulus.In fact,after these procedures,it has been demonstrated an up-regulation of pro-angiogenic and growth factors such as vascular endothelial growth factor-A,which might contribute to accelerated progression in patients with incomplete response.Several studies have demonstrated that MAP-kinase and AKT pathways,in addition to neo-angiogenesis,have an important role in the development of HCC.In advanced HCC,anti-angiogenic therapy and tyrosine kinases inhibitors showed potential clinical benefit.Actually,a number of clinical studies are ongoing testing these agents in combination with TACE or RFA.In this paper,we have reviewed the most recent preclinical and clinical results of such trials.

Pretreatment and analysis techniques development of TKIs in biological samples for pharmacokinetic studies and therapeutic drug monitoring

Tyrosine kinase inhibitors(TKIs)have emerged as the first-line small molecule drugs in many cancer therapies,exerting their effects by impeding aberrant cell growth and proliferation through the modulation of tyrosine kinase-mediated signaling pathways.However,there exists a substantial inter-individual variability in the concentrations of certain TKIs and their metabolites,which may render patients with compromised immune function susceptible to diverse infections despite receiving theoretically efficacious anticancer treatments,alongside other potential side effects or adverse reactions.Therefore,an urgent need exists for an up-to-date review concerning the biological matrices relevant to bioanalysis and the sampling methods,clinical pharmacokinetics,and therapeutic drug monitoring of different TKIs.This paper provides a comprehensive overview of the advancements in pretreatment methods,such as protein precipitation(PPT),liquid-liquid extraction(LLE),solid-phase extraction(SPE),micro-SPE(μ-SPE),magnetic SPE(MSPE),and vortex-assisted dispersive SPE(VA-DSPE)achieved since 2017.It also highlights the latest analysis techniques such as newly developed high performance liquid chromatography(HPLC)and high-resolution mass spectrometry(HRMS)methods,capillary electrophoresis(CE),gas chromatography(GC),supercritical fluid chromatography(SFC)procedures,surface plasmon resonance(SPR)assays as well as novel nanoprobes-based biosensing techniques.In addition,a comparison is made between the advantages and disadvantages of different approaches while presenting critical challenges and prospects in pharmacokinetic studies and therapeutic drug monitoring.

Combined transarterial chemoembolization and tislelizumab for patients with unresectable hepatocellular carcinoma

BACKGROUND Hepatocellular carcinoma(HCC)often presents as unresectable,necessitating effective treatment modalities.Combining transarterial chemoembolization(TACE)with immunotherapy and targeted therapy has shown promise,yet real-world evidence is needed.AIM To investigate effectiveness and safety of TACE with tislelizumab±targeted therapy for unresectable HCC in real-world setting.METHODS This retrospective study included patients with unresectable HCC receiving combined treatment of TACE and tislelizumab.The clinical outcomes included progression-free survival(PFS),overall survival(OS),objective response rate(ORR),and disease control rate(DCR).All patients were evaluated according to the mRECIST criteria.The adverse event(AE)was also assessed.RESULTS In this study of 56 patients with median follow-up of 10.9 months,7 had previous immunotherapy.Tislelizumab was administered before TACE in 21(37.50%)and after in 35(62.50%)patients,with 91.07%receiving concurrent targeted therapy.Median PFS was 14.0(95%CI:7.0-18.00)months,and OS was 28(95%CI:2.94-53.05)months.Patients with prior immunotherapy had shorter PFS(6 vs.18 months,P=0.006).Overall ORR and DCR were 82.14%and 87.50%.Grade≥3 treatment-related AEs included increased alanine aminotransferase(8.93%),aspartate aminotransferase(10.71%),and total bilirubin(3.57%).CONCLUSION The combination of TACE and tislelizumab,with or without targeted therapy,demonstrated promising efficacy and safety in unresectable HCC,especially in immunotherapy-naive patients,warranting further prospective validation studies.

Development and refinement of diagnostic and therapeutic strategies for managing patients with cardiogenic stroke:An arduous journey

Cardioembolic stroke,referred to as cardiogenic stroke,is a clinical syndrome in which emboli from the heart pass through the circulatory system and cause cerebral artery embolism and corresponding brain dysfunction.Compared to other subtypes of ischemic stroke,cardiogenic stroke presents with more etiologies,greater severity,worse prognosis,and a higher recurrence rate.In this minireview,we provide new insights into the etiological classification,diagnostic methods,and interventions of cardiogenic stroke.

Radiofrequency ablation combined with transarterial chemoembolization for unresectable primary liver cancer

Background Radiofrequency ablation （RFA） followed by transarterial chemoembolization （TACE） for unresectable primary liver cancer （PLC） has not been widely discussed. In this study, the outcome of the combination of RFA with TACE was retrospectively evaluated. Methods From May 2003 to March 2008, 127 consecutive PLC patients with a median age of 56.4＋8.8 years underwent RFA plus TACE. All patients were deemed to have unresectable PLC based on their tumor characteristics. The maximal diameter of the tumor was between 1.5 cm and 10.0 cm. Twenty-six cases with small （〈3.0 cm）, 33 with medium （3.1-5.0 cm）, and 68 with large （〉5.0 cm） tumors were included in this study. RFA was performed using a RITA Medical Systems expandable electrode device, which was followed by first-time TACE administration one to two months later. Results Technical success of RFA was achieved in all 127 patients with no severe treatment-related complications. RFA was performed percutaneously in 16 （13.5%） cases, by laparoscopic approach in 19 （15.7%）, and through laparotomy in the remaining 92 （72.4%）. RFA response was classified as complete ablation in 48 cases, nearly complete ablation in 28, and partial ablation in 51. The total 1-, 2-, and 3-year survival rates after RFA were 83.1%, 55.7%, and 43.7%, respectively. The survival rates at 3 years were 78.6%, 28.1%, and 0 for complete ablation, nearly complete ablation, or partial ablation groups, respectively. Three-year disease-free survival rates for the complete ablation and nearly complete ablation groups were 50.3% and 21.3%, respectively. RFA response and liver function were significant variables influencing survival time as analyzed using the Cox regression model. Conclusion RFA could be the first-line exterminate treatment for unresectable PLC, and TACE following RFA may assist in eradicatinq the peripheral viable tissue and micro-metastasis.

A Case Series of Liver Abscess Formation after Transcatheter Arterial Chemoembolization for Hepatic Tumors

Background： Liver abscess is a serious complication following transcatheter arterial chemoembolization （TACE）. Much attention has been paid to this condition as it may interfere with the treatment process and result in a poor prognosis of the patient. This study aimed to analyze the causes of liver abscess, a complication, after TACE for hepatic tumors and to summarize management approaches. Methods： From June 2012 to June 2014, of 1480 consecutive patients who underwent TACE at our hospital, five patients developed liver abscess alier TACE procedures for hepatic tumors. Of the five patients, each receiving conventional TACE, one underwent three sessions, two underwent two sessions, and the remaining two underwent one session of TACE. Demographic and clinical characteristics, together with management approaches and prognosis, were collected through a review of medical records. Results： These five patients were confirmed to have post-TACE liver abscess through clinical manifestations, laboratory, and imaging tests. Aiier percutaneous drainage and anti-inflammatory treatments, the symptoms present in four patients with liver abscess significantly improved as evidenced by shrinkage or disappearance of the abscess cavity, and the patients recovered completely after sufficient drainage. The remaining patient experienced recurrent symptoms and abdominal abscess, achieved no significant improvement after treatment, and eventually died of severe infection and multiple organ failures. Conclusions： TACE must be implemented with extreme caution to avoid liver abscess. An effective management relies on an early diagnosis, prompt use of sufficient doses of appropriate antibiotics, and active implementation of abscess incision, drainage, and aspiration.

Delayed cerebral lipiodol embolism after transcatheter arterial chemoembolization of hepatocellular carcinoma

Transcatheter arterial chemoembolization （TACE） has been an effective mean in treating hepatocellular carcinoma for nearly 30 years. The reported complications associated with TACE mainly include acute hepatic failure （accounting for 0.26%）, liver abscess （0.22%）, multiple intrahepatic aneurysms （0.17%）, hepatic artery occlusion （1.52%）, spontaneous rupture of tumor （0.15%）, gallbladder infarction （0.3%）, perforation of duodenum （0.05%）, acute renal failure （0.05%）,

Angio-Computed Tomograph-Guided Immediate Lipiodol Computed Tomograph for Diagnosis of Small Hepatocellular Carcinoma Lesions during Transarterial Chemoembolization

Background： The diagnosis and treatment of small hepatocellular carcinoma （HCC） play a vital role in the prognosis of patients with HCC. The purpose of our study was to evaluate anglo-computed tomography （angio-CT）-guided immediate lipiodol CT （a CT scan performed immediately after transarterial chemoembolization [TACE]） in the diagnosis of potential HCCs ≤1 cm in diameter. Methods： This study retrospectively analyzed 31 patients diagnosed with HCCs after routine imaging （contrast-enhanced CT or magnetic resonance imaging） or pathologic examinations with undefined or undetermined tumor lesions （diameter 〈1 cm） from February 2016 to September 2016. After TACE guided by digital subtraction angiography of the angio-CT system, potential HCC lesions with a diameter ≤1 cm were diagnosed by immediate lipiodol CT. The number of well-demarcated lesions was recorded to calculate the true positive rate. The correlation between the number of small HCCs detected by immediate lipiodol CT and the size of HCC lesions （diameter 〉1 cm） diagnosed preoperatively was analyzed 1 month after TACE. A paired t-test was used to analyze differences in liver function. Pearson analysis was used to analyze correlation. Chi-square test was used to compare the rates. Results： Fifty-eight lesions were detected on preoperative routine imaging examinations in 31 patients including 15 lesions with a diameter ≤ 1 cm. Ninety-one lesions were detected on immediate lipiodol CT, of which 48 had a diameter ≤ 1 cm. After 1 month, CT showed that 45 lesions had lipiodol deposition and three lesions had lipiodol clearance. Correlation analysis showed that the number of small HCCs detected by lipiodol CT was positively correlated with the size of HCC lesions diagnosed by conventional imaging examination （R^2 - 0.54, P 〈 0.05）. Conclusion： Immediate lipiodol CT may be a useful tool in the diagnosis of potential HCC lesions with a diameter of ≤1 cm.

Comparative efficacy and safety of Chinese herbal injections combined with transcatheter hepatic arterial chemoembolization in treatment of liver cancer: a bayesian network Meta-analysis

OBJECTIVE: To address the optimal Chinese herbal injections(CHIs) against liver cancer, the present network Meta-analysis is designed to investigate the comparative efficacy and safety of different CHIs.METHODS: Several electronic databases were searched up to June 1 st, 2017. The quality assessment was conducted and network Meta-analysis was performed to compare the efficacy and safety of different CHIs plus transcatheter hepatic arterial chemoembolization(TACE). Primary outcomes were 1-year and 2-year survival rate, the secondary outcomes includes the clinical effective rate, performance status and the adverse reactions(ADRs). Data analysis was applied Stata 13.0 and Win BUGS 1.4 software.RESULTS: A total of 105 randomized controlled trials(RCTs) were identified for inclusion in this analysis, with data for 7683 patients and 13 CHIs. The results suggested that Javanica oil emulsion,Huachansu injection plus TACE were more favorable for 1-year and 2-year survival rate than other CHIs. Kanglaite, Astragalus polysaccharide injection plus TACE showed superiority in the clinical effective rate and performance status over other CHIs.And Shenmai injection plus TACE was superior to reducing ADRs than other CHIs for patients with liver cancer.CONCLUSION: Our findings indicated that receiving CHIs combined with TACE may have therapeutic benefits for patients with liver cancer in improving survival rate, clinical effective rate, the performance status and alleviating the ADRs.

Prognostic analysis of transarterial chemoembolization combined with a traditional Chinese herbal medicine formula for treatment of unresectable hepatocellular carcinoma

Background Transarterial chemoembolization （TACE） is the most widely used primary treatment for unresectable hepatocellular carcinoma （HCC） due to its survival benefit, though its clinical effect is still far from satisfactory. Jiedufang （JDF） granule preparation is a commonly used Chinese herbal medicine formula for HCC. The aim of this study was to evaluate the effect of combined therapy with TACE and JDF granule preparation in treatment of unresectable HCC on survival. Methods A retrospective study of TACE was performed in 165 patients with unresectable HCC who were admitted between January 2002 and December 2007 in Changhai Hospital, Shanghai, China. Of the 165 patients, 80 patients （study group） received combined therapy consisting of TACE and a long-term maintenance treatment with oral JDF granule preparation, and the remaining 85 patients （control group） received TACE alone. The survival rates of both groups were calculated by the Kaplan-Meier method. Factors possibly affecting survival were assessed by multivariate analysis in the Cox proportional hazard model, such as maximum tumor size, number of lesions, portal vein invasion, and etc. Results The median overall survival was 9.2 months （95% CI： 6.94-11.46） in the study group versus 5.87 months （95% CI： 4.21-7.52） in the control group. In the study group,survival rates of the 1-, 2- and 3-year follow-up were 41.2%, 18.4%, and 9.6%, respectively. Significant independent prognostic factors identified by the Cox regression analysis were as follows： serum hepatitis B surface antigen （HBsAg） （P=0.014）, maximum tumor size （P=0.027）, number of lesions （P 〈0.001）, portal vein invasion （P 〈0.001）, and the therapy model （P=-0.006）. Conclusion Combination therapy of TACE and JDF granule preparation may significantly prolong survival of patients with unresectable HCC.

Effect of Aidi injection plus transarterial chemoembolization on primary hepatic carcinoma： a systematic review and Meta-analysis

OBJECTIVE: To assess the efficacy and safety of Aidi injection plus transarterial chemoembolization(TACE) in patients with primary hepatic carcinoma.METHODS: A comprehensive research of seven electronic databases was performed for comparative studies evaluating Aidi injection combined with TACE for primary hepatic carcinoma until September 2016. Two authors independently extracted data and assessed the methodological quality of the included trials using the Cochrane risk of bias tool from the Cochrane Handbook version 5.1.0. Data was synthesized by using Rev Man 5.3 software.RESULTS: Forty-nine studies involving 3435 patients met the inclusion criteria, most of which were low methodological quality. Compared with TACE alone, Aidi injection plus TACE can significantly improve the efficiency rate [RR = 1.33, 95% CI(1.24, 1.43), P < 0.000 01], clinical beneficial rate[RR = 1.25, 95% CI(1.17, 1.33), P < 0.000 01], survival rate [6 months, RR = 1.19, 95% CI(1.09, 1.29), P <0.0001], 12 months, [RR = 1.37, 95% CI(1.24, 1.52),P < 0.000 01], 18 months, [RR = 2.00, 95% CI(1.26,3.20), P < 0.004], 24 months, [RR = 1.44, 95% CI(1.22, 1.70), P < 0.0001], 36 months, [RR = 1.50, 95%CI(1.07, 2.11), P = 0.02 < 0.05], quality of life [RR =1.84, 95% CI(1.64, 2.05), P < 0.000 01] and immune function [CD3+, MD = 11.12, 95% CI(7.93, 14.30),P < 0.000 01], CD4 +, [MD = 10.37, 95% CI(7.29,13.45), P < 0.000 01], CD4+/CD8+, [MD = 0.30, 95%CI(0.07, 0.53), P = 0.01 < 0.05], NK, [MD = 7.49, 95%CI(6.64, 8.34), P < 0.000 01]. A significant improvement was also found in improvement of symptoms[RR = 1.64, 95%CI(1.38, 1.94), P < 0.000 01], leukopenia [RR = 0.60, 95% CI(0.54, 0.66), P < 0.000 01],thrombocytopenia [RR = 0.46, 95% CI(0.34, 0.61),P < 0.000 01], nausea and vomiting incidence [RR =0.66, 95% CI(0.54, 0.81), P < 0.0001), liver damage rate [RR = 0.57, 95% CI(0.42, 0.77), P = 0.0003 <0.05), and kidney damage rate [RR = 0.18, 95% CI(0.05, 0.68), P = 0.01 < 0.05].CONCLUSION: The results suggested that Aidi injection plus TACE significantly improve the clinical effect of TACE, and reduce the incidence of adverse events. However, rigorous multicenter trials with larger size are warranted to further confirm the findings.

Prevalence and prognostic impact of hepatopulmonary syndrome in patients with unresectable hepatocellular carcinoma undergoing transarterial chemoembolization: a prospective cohort study

Background::To determine the prevalence and prognostic impact of hepatopulmonary syndrome(HPS)in patients with unresectable hepatocellular carcinoma(HCC)undergoing transarterial chemoembolization(TACE).Methods::Fifty-four patients with unresectable HCC undergoing TACE between December 2014 and December 2015 were prospectively screened for HPS and were followed up for a maximum of 2 years or until the end of this prospective study.Results::Nineteen of the 54(35.2%)patients were considered to have HPS,including one(5.3%)with severe HPS,nine(47.4%)with moderate HPS,and nine(47.4%)with mild HPS.The median overall survival(OS)was 10.1(95%confidence interval[CI],3.9–16.3)months for patients with HPS and 15.1(95%CI,7.3–22.9)months for patients without HPS,which is not a significant difference(P=0.100).The median progression-free survival was also not significantly different between patients with and without HPS(5.2[95%CI,0–12.8]vs.8.4[95%CI,3.6–13.1]months;P=0.537).In the multivariable Cox regression analyses,carbon monoxide diffusing capacity(hazard ratio[HR]=1.033[95%CI,1.003–1.064];P=0.028)and Child-Pugh class(HR=1.815[95%CI,1.011–3.260];P=0.046)were identified to be the independent prognostic factors of OS.Conclusion::Mild or moderate HPS is common in patients with unresectable HCC undergoing TACE,but it does not seem to have a significant prognostic impact.