Advances in Research of Post Embolism Syndrome after Transarterial Chemoembolization(TACE)for Hepatocellular Carcinoma

This article reviews the concept and clinical manifestations of post embolism syndrome after transarterial chemoembolization(TACE),and the prevention or timely intervention of post embolism syndrome in advance is expected to reduce its incidence and degree in clinical treatment,and to improve the quality of treatment of Hepatocellular Carcinoma Carcinoma(HCC).

Current research status of transarterial therapies for hepatocellular carcinoma

With continuous advancements in interventional radiology,considerable progress has been made in transarterial therapies for hepatocellular carcinoma(HCC)in recent years,and an increasing number of research papers on transarterial therapies for HCC have been published.In this editorial,we comment on the article by Ma et al published in the recent issue of the World Journal of Gastrointestinal Oncology:“Efficacy and predictive factors of transarterial chemoembolization combined with lenvatinib plus programmed cell death protein-1 inhibition for unresectable HCC”.We focus specifically on the current research status and future directions of transarterial therapies.In the future,more studies are needed to determine the optimal transarterial local treatment for HCC.With the emergence of checkpoint immunotherapy modalities,it is expected that the results of trials of transarterial local therapy combined with systemic therapy will bring new hope to HCC patients.

Efficacy and safety analysis of transarterial chemoembolization and transarterial radioembolization in advanced hepatocellular carcinoma descending hepatectomy

BACKGROUND Hepatocellular carcinoma(HCC)is one of the most common malignant tumors in the world,which is seriously threatening the lives of patients.Due to the rapid development of the disease,patients were in the middle and advanced stages at the time of diagnosis and missed the best time for treatment.With the development of minimally invasive medicine,interventional therapy for advanced HCC has achieved promising results.Transarterial chemoembolization(TACE)and transarterial radioembolization(TARE)are currently recognized as effective treatments.This study aimed to investigate the clinical value and safety of TACE alone and combined with TACE in the treatment of progression in patients with advanced HCC and to find a breakthrough for the early diagnosis and treatment of patients with advanced HCC.AIM To investigate the efficacy and safety of hepatic TACE and TARE in advanced descending hepatectomy.METHODS In this study,218 patients with advanced HCC who were treated in the Zhejiang Provincial People’s Hospital from May 2016 to May 2021 were collected.Of the patients,119 served as the control group and received hepatic TACE,99 served as the observation group and were treated with hepatic TACE combined with TARE.The patients in two groups were compared in terms of lesion inactivation,tumor nodule size,lipiodol deposition,serum alpha-fetoprotein(AFP)level in different periods,postoperative complications,1-year survival rate,and clinical symptoms such as liver pain,fatigue,and abdominal distension,and adverse reactions such as nausea and vomiting.RESULTS The observation group and the control group had good efficacy in treatment efficiency,reduction of tumor nodules,reduction of postoperative AFP value,reduction of postoperative complications,and relief of clinical symptoms.In addition,compared with the control group,the treatment efficiency,reduction of tumor nodules,reduction of AFP value,reduction of postoperative complications,and relief of clinical symptoms in the observation group were better than those in the TACE group alone.Patients in the TACE+TARE group had a higher 1-year survival rate after surgery,lipiodol deposition was significantly increased and the extent of tumor necrosis was expanded.The overall incidence of adverse reactions in the TACE+TARE group was lower than that in the TACE group,and the difference had statistical significance(P<0.05).CONCLUSION Compared with TACE alone,TACE combined with TARE is more effective in the treatment of patients with advanced HCC.It also improves postoperative survival rate,reduces adverse effects,and has a better safety profile.

Efficacy of continuous arterial perfusion chemotherapy combined with transarterial chemoembolization regional arterial thermal perfusion in the treatment of pancreatic cancer with liver metastases

Background:The aim of the study was to investigate the efficacy of continuous transcatheter arterial infusion chemotherapy combined with transarterial chemoembolization(TACE)for the treatment of advanced pancreatic cancer with liver metastasis.Methods:Sixty patients with advanced pancreatic cancer and liver metastases were enrolled in this study.In the treatment group,31patients underwent continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial thermal perfusion,whereas 29 patients included in the control group received intravenous chemotherapy with gemcitabine and S-1.All patients received maintenance chemotherapy with S-1 after 4 cycles of the study regimen.Treatment efficacy,quality of life,survival,and toxicity were evaluated.Results:Efficacy was better in the treatment group than in the control group,as reflected by the objective remission,partial remission,and disease progression rates(all P<0.05).The Eastern Cooperative Oncology Group and Numerical Rating Scale pain scores were also higher in the treatment group(both P<0.05).In survival analysis,the 1-year overall survival rates in the treatment and control groups were64.516%and 10.345%,respectively,whereas the median overall survival times were 16 and 6 months,respectively(both P<0.05).The6-month progression-free survival rates in the treatment and control groups were 77.419%and 13.790%,respectively,and the median progression-free survival times were 12 and 3 months,respectively(both P<0.05).The rates of hematological and nonhematological toxicological adverse effects were also lower in the treatment group(both P<0.05).Although the rate of liver dysfunction was higher in the treatment group,this finding had no adverse effects on prognosis.Conclusions:Continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial perfusion chemotherapy resulted in better efficacy and safety outcomes in patients with pancreatic cancer and liver metastasis,suggesting its utility as a reference method for the clinical treatment of advanced pancreatic cancer.

X射线血管造影在肝癌介入TACE术后复发、疗效及肝脏肿瘤灌注减少的评估价值

目的:探讨X射线血管造影在肝癌介入经导管动脉化疗栓塞术(TACE)术后复发、疗效及肝脏肿瘤灌注减少的评估价值。方法:选取2015年1月至2020年12月于蚌埠市第三人民医院接受治疗的59例肝癌患者,所有患者术前1周、术后4周均行常规X射线血管造影检查,将获得的影像序列导入装有彩色编码数字减影血管造影(ccDSA)成像技术软件的工作站进行分析,在TACE前后的ccDSA图像上手动定义感兴趣区域(ROI),获得时间强度曲线并从中导出达峰时间(TTP)、受试者工作特征(ROC)曲线下面积(AUC)及最大斜率(MS)等定量灌注参数。通过其计算AUC,分析灌注参数对肝癌TACE术后复发、疗效及肝脏肿瘤灌注减少的评估效能。结果:纳入研究的59例患者根据术后复发定义,术后复发39例,未复发20例,术后复发患者灌注TTP(7.38±1.22)s明显低于未复发患者(9.03±1.01)s,差异有统计学意义(t=5.198,P<0.05),AUC、MS明显低于术后未复发患者,差异有统计学意义(t=10.741、31.499,P<0.05),术后复发和未复发患者术前TTP、AUC及MS比较,差异无统计学意义(P>0.05)。根据疗效判定标准,有效35例,无效24例,有效患者术后TTP(9.09±1.08)s明显高于无效患者(7.84±2.07)s,差异有统计学意义(t=3.029,P<0.05),AUC、MS明显高于无效患者,差异有统计学意义(t=3.852、54.366,P<0.05),有效患者和无效患者术前TTP、AUC及MS比较,差异均无统计学意义(P>0.05),有效患者和无效患者术后TTP、AUC及MS均高于术前,两组比较差异有统计学意义(t=3.029、3.852、54.366,P<0.05)。根据主观血管造影栓塞端点(SACE)分级标准,Ⅲ级33例,Ⅳ级26例,Ⅲ级和Ⅳ级患者术前TTP、AUC及MS比较,差异无统计学意义(P>0.05),Ⅳ级患者术后TTP、AUC及MS均明显低于Ⅲ级患者,两组比较差异有统计学意义(t=7.697、3.498、58.968,P<0.05)。TTP、AUC及MS评估肝癌介入TACE术后复发的灵敏度为66.70%、89.70%和59.00%,特异度为55.00%、55.00%和55.00%,TTP、AUC及MS评估肝癌介入TACE术后复发的AUC分别为0.629(95%CI:0.478~0.779)、0.827(95%CI:0.723~0.931)和0.512(95%CI:0.356~0.667);TTP、AUC及MS评估肝癌介入TACE术后疗效的灵敏度为64.10%、79.50%、61.50%,特异度为55.00%、65.00%和55.00%,TTP、AUC及MS评估肝癌介入TACE术后疗效的AUC分别为0.609(95%CI:0.462~0.756)、0.808(95%CI:0.698~0.918)和0.580(95%CI:0.413~0.747);TTP、AUC及MS评估肝癌介入TACE术后肝脏肿瘤灌注减少的灵敏度为69.20%、82.10%和53.80%,特异度为70.00%、75.00%和55.00%,TTP、AUC及MS评估肝癌介入TACE术后肝脏肿瘤灌注减少的AUC分别为0.745(95%CI:0.613~0.877)、0.842(95%CI:0.724~0.960)和0.507(95%CI:0.360~0.654)。结论:X射线血管造影检查后的数据通过ccDSA的定量分析获得的TTP、AUC及MS灌注参数,对肝癌介入TACE术后复发、疗效及肝脏肿瘤灌注减少的评估均具有一定应用价值。

Hepatic artery infusion chemotherapy using mFOLFOX versus transarterial chemoembolization for massive unresectable hepatocellular carcinoma:a prospective non.randomized study

Background: Transarterial chemoembolization(TACE) is recommended as the standard care for unresectable hepatocellular carcinoma(HCC) at Barcelona Clinic Liver Cancer(BCLC) stage A-B. However, the efficacy of TACE on large(> 10 cm) stage A-B HCC is far from satisfactory, and it is proposed that hepatic artery infusion chemotherapy(HAIC)might be a better first-line treatment of this disease. Hence, we compared the safety and efficacy of HAIC with the modified FOLFOX(mFOLFOX) regimen and those ofTACE in patients with massive unresectable HCC.Methods: A prospective, non-randomized, phase II study was conducted on patients with massive unresectable HCC. The protocol involved HAIC with the mFOLFOX regimen(oxaliplatin, 85 mg/m^2 intra-arterial infusion; leucovorin,400 mg/m^2 intra-arterial infusion; and fluorouracil, 400 mg/m2 bolus infusion and 2400 mg/m^2 continuous infusion)every 3 weeks and TACE with 50 mg of epirubicin, 50 mg of lobaplatin, 6 mg of mitomycin, and lipiodol and polyvinyl alcohol particles. The tumor responses, time-to-progression(TTP), and safety were assessed.Results: A total of 79 patients were recruited for this study: 38 in the HAIC group and 41 in the TACE group. The HAIC group exhibited higher partial response and disease control rates than did the TACE group(52.6% vs. 9.8%, P < 0.001;83.8% vs. 52.5%, P = 0.004). The median TTPs for the HAIC and TACE groups were 5.87 and 3.6 months(hazard radio[HR] = 2.35,95% confidence interval [CI] = 1.16-4.76, P = 0.015). More patients in the HAIC group than in the TACE group underwent resection(10 vs. 3,P = 0.033). The proportions of grade 3-4 adverse events(AE) and serious adverse events(SAE) were lower in the HAIC group than in the TACE group(grade 3-4 AEs: 13 vs. 27, P = 0.007;SAEs: 6 vs. 15,p = 0.044). More patients in the TACE group than in the HAIC group had the study treatment terminated early due to intolerable treatment-related adverse events or the withdrawal of consent(10 vs. 2,P = 0.026).Conclusions: HAIC with mFOLFOX yielded significantly better treatment responses and less serious toxicity than did TACE. HAIC might represent a feasible and promising first-line treatment for patients with massive unresectable HCC.

Combination of percutaneous radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma: observation of clinical effects

Objective： To observe the clinical effect of radiofrequency ablation （RFA） combined with transcatheter arterial chemoembolization （TACE） for advanced hepatocellnlar carcinoma （HCC）. Methods： A total of 92 eases of advanced primary liver cancer underwent TACE and RFA treatment from June 2005 to 2011 at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College. A total of 88 cases with complete clinical treatment and follow-up data were divided into two groups： 43 patients treated with TACE （TACE group） and 45 patients that received TACE combined with RFA treatment （TACE ＋ RFA group）. After clinical data assessment, tumor size and survival status were not significantly different between the groups as determined by stratified analysis. Results： Before and after surgery, spiral CT radiography and color comparison observed ablation conditions. The tumor necrosis rates after treatment （CR ＋ PR） were 67.4% （29/43） and 91.1% （41/45） for the TACE and combined treatment groups, respectively, and the difference was statistically significant （P〈0.05）. The quality of life was significantly improved for patients undergoing TACE ~ RFA compared with the control group. Survival duration was not significantly different in patients undergoing TACE ~ RFA compared with the control group. Conclusions： In this study, the effect of RFA combined with TACE treatment was better than TACE alone in treating advanced HCC.

Prognostic factors for transarterial chemoembolization combined with sustained oxaliplatin-based hepatic arterial infusion chemotherapy of colorectal cancer liver metastasis

Objective： To investigate the prognostic factors in chemorefractory colorectal cancer liver metastasis（CRCLM）patients treated by transarterial chemoembolization（TACE） and sustained hepatic arterial infusion chemotherapy（HAIC）.Methods： Between 2006 and 2015, 162 patients who underwent 763 TACE and HAIC in total were enrolled in this retrospective study, including 110 males and 52 females, with a median age of 60（range, 26–83） years.Prognostic factors were assessed with Log-rank test, Cox univariate and multivariate analyses.Results： The median survival time（MST） and median progression-free survival（PFS） of the 162 patients from first TACE/HAIC were 15.6 months and 5.5 months respectively. Normal serum carbohydrate antigen 19-9（CA19-9, 〈37 U/m L）（P〈0.001） and carbohydrate antigen 72-4（CA72-4, 〈6.7 U/m L）（P=0.026）, combination with other local treatment（liver radiotherapy or liver radiofrequency ablation）（P=0.034） and response to TACE/HAIC（P〈0.001） were significant factors related to survival after TACE/HAIC in univariate analysis. A multivariate analysis revealed that normal serum CA19-9（P〈0.001）, response to TACE/HAIC（P〈0.001） and combination with other local treatment（P=0.001） were independent factors among them.Conclusions： Our findings indicate that serum CA19-9 〈37 U/m L and response to TACE/HAIC are significant prognostic indicators for this combined treatment, and treated with other local treatment could reach a considerable survival benefit for CRCLM. This could be useful for making decisions regarding the treatment of CRCLM.

Safety and efficacy of hepatic arterial infusion chemotherapy with raltitrexed and oxaliplatin post-transarterial chemoembolization for unresectable hepatocellular carcinoma

Objective:To investigate the safety,efficacy,and prognostic factors of hepatic arterial infusion chemotherapy(HAIC)with raltitrexed and oxaliplatin post-transarterial chemoembolization(TACE)for unresectable hepatocellular carcinoma(uHCC).Methods:Thirty-seven patients with uHCC who received HAIC with raltitrexed and oxaliplatin post-TACE between June 2014 and December 2016 at our hospital were recruited.The primary endpoint was overall survival(OS),and secondary endpoint was progression-free survival(PFS).The overall response rate(ORR)was evaluated using the modified Response Evaluation Criteria in Solid Tumors.Toxicity was assessed according to the Common Terminology Criteria for Adverse Events(v4.0).The OS and prognostic factors were analyzed using the Kaplan-Meier method,log-rank test,and Cox regression models.Results:Three(8.1%)patients achieved complete response,17(46.0%)patients achieved partial response,and the ORR was54.0%.The median OS and median PFS were 19.0 months and 12.0 months,respectively.The common toxicities included grade 3-4 increased aspartate aminotransferase levels(8/37,21.6%),grade 1-2 hyperbilirubinemia(75.7%,28/37),nonspecific abdominal pain and fever,and grade 2-3 thrombocytopenia(18.9%,7/37);no patients developed grade 3-4 neutropenia.Univariate analysis showed that the tumor diameter(≤50 mm,p=0.028),Barcelona Clinic Liver Cancer(BCLC)stage(p=0.012),hepatitis B virus DNA level(p=0.033),and derived neutrophil-to-lymphocyte ratio(dNLR;derived neutrophils/leukocytes minus neutrophils)(p=0.003)were predictive factors for prognosis.Multivariate analysis showed that patients with BCLC stage B disease(p=0.029)and dNLR<2 before therapy(p=0.004)had better prognosis.Conclusions:HAIC with raltitrexed and oxaliplatin post-TACE is a safe and efficacious therapy for patients with uHCC;in particular,those with BCLC stage B and dNLR<2 have better prognosis.

Is hepatic arterial infusion chemotherapy effective treatment for advanced hepatocellular carcinoma resistant to transarterial chemoembolization?

AIM:To evaluate the effectiveness of hepatic arterial infusion chemotherapy(HAIC) for advanced hepatocellular carcinoma(HCC) resistant to transarterial chemoembolization(TACE).METHODS:This study was conducted on 42 patients who received HAIC for advanced HCC between 2001and 2010 at our hospital.5-fluorouracil(5-FU) was administered continuously for 24 h from day 1 to day 5 every 2-4 wk via an injection reservoir.Intra-arterial cisplatin or subcutaneous interferon was administered in combination with the 5-FU.The patients enrolled in this retrospective study were divided into two groups according to whether or not they fulfilled the criteria for resistance to TACE proposed by the Japan Society of Hepatology in 2010(written in Japanese);one group of patients who did not fulfill the criteria for TACE resistance(group A,n = 23),and another group who fulfilled the criteria for TACE resistance(group B,n = 19).We compared the outcomes in terms of the response and survival rates between the two groups.RESULTS:Both the response rate and tumor suppression rate following HAIC were significantly superior in group A than in group B(response rate:48% vs 16%,P = 0.028,tumor suppression rate:87% vs 53%,P = 0.014).Furthermore,both the progression-free survival rate and survival time were significantly superior in group A than in group B(3-,6-,12-,and 24-mo = 83%,70%,29% and 20% vs 63%,42%,16% and 0%,respectively,P = 0.040,and 9.8 mo vs 6.2 mo,P = 0.040).A multivariate analysis(Cox proportional hazards regression model) showed that resistance to TACE was an independent predictor of poor survival(P = 0.007).CONCLUSION:HAIC administrating 5-FU was not effective against advanced HCC resistant to TACE.Other tools for treatment,i.e.,molecular-targeting agents may be considered for these cases.

Effect of double platinum agents, combination of miriplatintransarterial oily chemoembolization and cisplatinhepatic arterial infusion chemotherapy, in patients with hepatocellular carcinoma: Report of two cases

Hepatocellular carcinoma(HCC) is one of the most common cancers and the third highest cause of cancerassociated mortality worldwide. The treatment of HCC is complicated by its variable biological behavior and the frequent coexistence of chronic liver disease, particularly cirrhosis. To date, multiple treatment modalities have been developed according to the stage of the tumor and the hepatic functional reserve, including transarterial treatments such as transarterial chemoembolization, transarterial oily chemoembolization(TOCE), and hepatic arterial infusion chemotherapy(HAIC). We conducted a phase I and II study of the combination therapy with double platinum agents, miriplatin and cisplatin, and confirmed its safety and efficacy. Here, we describe two cases of unresectable HCC who were successfully treated by miriplatin-TOCE/cisplatin-HAIC combination therapy, resulting in complete responses with no significant adverse events. This report will provide that the combination therapy can be the therapeutic option for HCC patients in the advanced stage.

Transarterial chemoembolization with drug-eluting beads in hepatocellular carcinoma

Transarterial chemoembolization(TACE) is a widely used standard treatment for patients with hepatocellular carcinoma(HCC) who are not suitable candidates for curative treatments. The rationale for TACE is that intra-arterial chemotherapy using lipiodol and chemotherapeutic agents, followed by selective vascular embolization, results in a strong cytotoxic effect as well as ischemia(conventional TACE). Recently, drugeluting beads(DC Beads?) have been developed for transcatheter treatment of HCC to deliver higher doses of the chemotherapeutic agent and to prolong contact time with the tumor. DC Beads? can actively sequester doxorubicin hydrochloride from solution and release it in a controlled sustained fashion. Treatment with DC Beads? substantially reduced the amount of chemotherapeutic agent that reached the systemic circulation compared with conventional, lipiodol-based regimens, significantly reducing drug-related adverse events. In this article, we describe the treatment response, survival, and safety of TACE used with drugeluting beads for the treatment of HCC and discuss future therapeutic possibilities.

Transarterial chemoembolization with hepatic arterial infusion chemotherapy plus S-1 for hepatocellular carcinoma

BACKGROUND Transarterial chemoembolization(TACE)and hepatic arterial infusion chemotherapy(HAIC)have shown promising local benefits for advanced hepatocellular carcinoma(HCC).S-1,a composite preparation of a 5-fluorouracil prodrug,has proven to be a convenient oral chemotherapeutic agent with definite efficacy against advanced HCC.AIM To evaluate the efficacy and safety of TACE followed by HAIC with or without oral S-1 for treating advanced HCC.METHODS In this single-center,open-label,prospective,randomized controlled trial,117 participants with advanced HCC were randomized to receive TACE followed by oxaliplatin-based HAIC either with(TACE/HAIC+S-1,n=56)or without(TACE/HAIC,n=61)oral S-1 between December 2013 and September 2017.Two participants were excluded from final analysis for withdrawing consent.The primary endpoint was progression-free survival(PFS)and secondary endpoints included overall survival(OS),objective response rate,disease control rate and safety.RESULTS In total,115 participants(100 males and 15 females;mean age,57.7 years±11.9)were analyzed.The median PFS and OS were 5.0 mo(0.4–58.6 mo)(95%confidence interval(CI):3.82 to 6.18)vs 4.4 mo(1.1–54.4 mo)(95%CI:2.54 to 6.26;P=0.585)and 8.4 mo(0.4–58.6 mo)(95%CI:6.88 to 9.92)vs 8.3 mo(1.4–54.4 m)(95%CI:5.71 to 10.96;P=0.985)in the TACE/HAIC+S-1 and TACE/HAIC groups,respectively.The objective response rate and disease control rate were 30.9%vs 18.4%and 72.7%vs 56.7%in the TACE/HAIC+S-1 and TACE/HAIC groups,respectively.Grade 3/4 adverse events had a similar frequency in both treatment groups.CONCLUSION No improvements in tumor response rates,PFS or OS were observed with the addition of S-1 to TACE/HAIC in advanced HCC.Both treatment regimens had a similar safety profile.

Efficacy of intra-arterial contrast-enhanced ultrasonography during transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma

AIM To assess the usefulness of intra-arterial contrastenhanced ultrasonography(IAUS) during transarterial chemoembolization(TACE) with drug-eluting beads(DEB) for hepatocellular carcinoma(HCC).METHODS Thirty two patients with 39 HCC underwent DEB-TACE guided with IAUS, and examined by contrast-enhanced ultrasonography(CEUS) or dynamic CT after DEB-TACE were enrolled in this study. CEUS findings before DEBTACE and IAUS findings were compared. Treatments judged to be complete and incomplete for lesions were appropriate and insufficient, respectively. Findings on CEUS and/or dynamic CT performed 1, 3 and 6 mo after DEB-TACE were evaluated using m RECIST(CR/PR/SD/PD).RESULTS The treatments were complete and incomplete in 26 and 13 lesions, respectively. On imaging evaluation using CEUS and/or dynamic CT one month after treatment, 25 and 1 lesions were judged to be CR and PR, respectively, and at 6 mo after treatment, the results were CR, PR, SD and PD for 24, 1, 0 and 1 of these lesions, respectively, in the 26 completely treated lesions. Of the 13 lesions in which treatment was incomplete, the results on imaging at one month after treatment were CR, PR, SD and PD for 0, 6, 4 and 3 lesions, respectively. The overall CR rate at 6 mo after treatment was 61.5%(24/39).CONCLUSION A combination of DEB-TACE with IAUS can improve the therapeutic effects in patients with HCC.

DEB-TACE联合C-TACE治疗巨块型肝癌的近期疗效及安全性研究

目的探讨经动脉载药微球化疗栓塞(DEB-TACE)联合常规经动脉化疗栓塞(C-TACE)治疗巨块型肝癌的近期疗效及安全性。方法回顾性分析2017年8月至2020年9月于桂林医学院附属医院和广西医科大学附属肿瘤医院接受介入治疗的44例巨块型肝癌患者的临床资料,其中27例采用DEB-TACE联合C-TACE治疗作为观察组,17例采用单独DEB-TACE治疗作为对照组。采用改良实体瘤疗效评价标准(mRECIST)对两组患者的近期疗效进行评价。比较两组手术前后生化指标变化情况及术后不良反应发生情况。结果两组术后1个月和3个月疾病客观缓解率(ORR)和疾病控制率(DCR)比较差异无统计学意义(P>0.05)。两组术后总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、凝血酶原时间(PT)、白细胞(WBC)、血尿素氮(BUN)水平均呈先上升后下降的趋势,血小板(PLT)水平呈先下降后上升的趋势,甲胎蛋白(AFP)、白蛋白(ALB)、血红蛋白(Hb)、肌酐(CREA)水平呈下降趋势,两组各指标变化幅度比较差异无统计学意义(P>0.05)。两组发热、腹痛、恶心呕吐、便秘及骨髓抑制等不良反应发生率比较差异无统计学意义(P>0.05)。结论DEB-TACE联合C-TACE治疗巨块型肝癌的近期疗效不优于单纯DEB-TACE。

TACE联合抗血管生成药治疗不可切除PLC有效性和安全性的网状Meta分析

目的系统评价经动脉化疗栓塞术(TACE)联合抗血管生成药治疗不可切除原发性肝癌(PLC)的有效性和安全性。方法检索中国知网、the Cochrane Library等中英文数据库和Google、百度学术,收集TACE联合抗血管生成药治疗不可切除PLC的随机对照试验(RCT),检索时限均为建库至2024年5月27日。筛选文献、提取资料、评价文献质量后,采用R 4.2.2和Stata 17.0软件进行网状Meta分析。结果共纳入44项RCT,共计5607例患者,涉及8种干预措施。网状Meta分析结果显示,在延长中位总生存期(mOS)、中位无进展生存期(m PFS)方面,以TACE+阿帕替尼疗效最优,网状Meta排序前2位的为TACE+阿帕替尼、TACE+索拉非尼;在提高客观缓解率(ORR)和疾病控制率(DCR)方面,以TACE+多纳非尼疗效最优,网状Meta排序前2位的为TACE+多纳非尼、TACE+仑伐替尼;安全性方面,以TACE+多纳非尼最优,网状Meta排序前2位的为TACE+多纳非尼、TACE+阿帕替尼。结论TACE+阿帕替尼、TACE+多纳非尼用于不可切除PLC患者的疗效均较好,且以TACE+多纳非尼的安全性最优。

Analysis of tumor recurrence factors in patients of primary hepatocellular carcinoma with postoperative transcatheter arterial chemoembolization (TACE)

Objective： The aim of the study was to analyze the tumor recurrence factors in patients of primary hepatocellular carcinoma （PHC） with postoperative transcatheter arterial chemoembolization （TACE）. Methods： A total of 121 cases of PHC by TACE after 1-2 months of surgery was retrospectively analyzed, followed up and analyzed the free survival time and the factors related to tumor-free survival. Results： In all 121 cases, 1-, 2-, and 3-year tumor-free survival rates were 72.73%, 46.21% and 26.93%, respectively. Gender, age, HBV infection, tumor size, capsule is complete, degree of differentiation and the presence of vascular thrombosis were put into the COX proportional hazards model of survival time to select the influential variables. In the clinical data of all variables entering COX proportional hazards model, tumor size, tumor differentiation and the presence of vascular thrombosis were statistically significant contributions to the model. In the tumor diameter less than or equal 10 cm [P = 0.040, Exp （B） = 2.210], vascular thrombosis [P = 0.039, Exp （B） = 2.922] and the lower degree of tumor differentiation [P = 0.035, Exp （B） = 3.038], the risk of tumor recent recurrence increased. Conclusion： Tumor size, differentiation, and the presence of vascular thrombosis are the independent risk factors affecting the prognosis of PHC after TACE.

Rupture of hepatocellular carcinoma following transarterial embolization/chemoembolization: two cases report and systematic review

Objective: Rupture of hepatocellular carcinoma (HCC) following transarterial embolization/chemoembolization (TAE/TACE) is a rare but life-threatening complication. The aim of the study was to explore the incidence, risk factors, clinical characteristics, treatment, and outcomes of this complication. Methods: We described two cases and reviewed all cases of ruptured HCC after TAE/TACE reported in the literature. Results: Our search yielded 32 cases of ruptured HCC after TAE/TACE. The overall incidences were 0.45% per patient and 0.21% per session. The mean age of the patients was 57.4 years (range 28-90 years, n=26, No. of cases with available information). Males accounted for 81% of cases (21/26). The 50% of the cases had histories of primary hypertension, diabetes or peripheral artery disease (6/12). Mean diameter of the tumors was 11.4 cm (range 3-20 cm, n=27). The 100% of cases had superficial or exophytic tumors (23/23). Portal vein thrombosis was presented in 61.5% of patients (8/13). The median interval between TAE/TACE and rupture was 2 days (range 0 hour-30 days, n=31). Management choices included emergency TAE, surgery, and conservative treatment. The overall median survival time was 7 days (n=19). Conclusion: Rupture of HCC following TAE/TACE is relatively rare but potentially life-threatening. The management is difficult and prognosis is poor. Large tumor size, superficial or exophytic tumors as well as portal vein thrombosis and comorbidities such as primary hypertension, diabetes or peripheral artery disease may be predisposing factors for rupture.

Changes in the frequency of myeloid-derived suppressor cells after transarterial chemoembolization with gelatin sponge microparticles for hepatocellular carcinoma

Purpose: A series of clinical studies have established the safety and efficacy of transcatheter arterial chemoembolization(TACE) with gelatin sponge microparticles(GSMs) in treating hepatocellular carcinoma(HCC). HCC can lead to obvious necrosis inside tumors, especially larger ones, although it is unclear whether such necrotic tumor tissue can induce favorable immune reactions against the tumor. Myeloid-derived suppressor cells(MDSCs)have immunosuppressive functions and are currently considered a very important cell type affecting tumor immunity. This study observed changes in MDSC frequency in peripheral blood before and after GSM–TACE to evaluate the effect on the immune function of HCC patients.Methods: Eight patients diagnosed with HCC underwent GSM–TACE treatment in the Hepatobiliary Interventional Department of Beijing Tsinghua Chang Gung Hospital, Beijing, China;we followed up with the patients over a period of 30 days post-surgery. We used flow cytometry(FCM) to quantify the frequency of MDSCs in peripheral blood before TACE, 10 days after surgery and 30 days after surgery.Results: MDSC frequency after GSM–TACE had a significant downward trend. Pre-TACE, it was 30.73% ? 11.93%,decreasing to 18.60% ? 11.37% at 10 days after operation. This decrease was not statistically significant(P > 0.05). MDSC frequency was even lower 30 days after TACE(7.63% ? 7.32%) than at 10 days after TACE(P < 0.05), and there was a significant difference compared with pre-TACE(P < 0.001). We evaluated tumor response at 30 days after GSM–TACE according to the Modified Response Evaluation Criteria in Solid Tumors(mRECIST), and all eight patients showed partial response(PR).Conclusion: Our results confirmed that GSM–TACE was beneficial for improving anti-tumor immunity in the treatment of HCC.

TACE同步微波消融与TACE治疗不同病理分级神经内分泌肿瘤肝转移的临床疗效比较

目的对比分析经导管动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)同步联合微波消融与单纯TACE在不同病理分级的神经内分泌肿瘤肝转移患者中的疗效及安全性。方法回顾性分析2006年11月1日至2022年7月31日复旦大学附属中山医院介入治疗科收治的神经内分泌肿瘤肝转移患者,根据治疗方式分为同步消融组和TACE组,并根据病理分级分成相应的亚组,通过术后影像学检查评估病灶,随访至2023年7月31日,记录手术相关并发症,随访终点为患者的无进展生存期(progression-free survival,PFS)及总生存期(overall survival,OS)。结果共纳入86例神经内分泌肿瘤患者,同步消融组34例,TACE组52例。根据2019年WHO消化系统神经内分泌肿瘤的分类和分级标准,将患者分为G1期(21例)、G2期(45例)、G3期(20例)。所有患者均未出现严重的术后并发症。TACE组和同步消融组中位OS分别为47.0(95%CI:31.2~62.8)个月和56.0(95%CI:38.3~73.4)个月,差异无统计学意义(P=0.50);中位PFS分别为18.0(95%CI:6.0~30.0)个月和29.0(95%CI:10.0~48.0)个月,差异无统计学意义(P=0.22)。45例G2期患者中27例接受TACE,中位OS为47.0个月,18例接受同步消融,中位OS是59.0个月,两组差异无统计学意义(P=0.45)。TACE组和同步消融组中位PFS分别为12.0个月和32.0个月,差异有统计学意义(P=0.03)。结论与单独TACE治疗相比,TACE同步微波消融可以延缓神经内分泌肿瘤肝转移患者的病情进展,具有较好的安全性,且更适用于中、低级别的神经内分泌肿瘤肝转移患者。