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Drug-eluting bead transarterial chemoembolization is an effective downstaging option for subsequent radical treatments in patients with hepatocellular carcinoma: A cohort study - 27/10/20

Doi : 10.1016/j.clinre.2020.09.002 
Liang Cai, Honglu Li, Jiang Guo, Wenpeng Zhao, Youjia Duan, Xiaopu Hou, Long Cheng, Hongliu Du, Xihong Shao, Zhenying Diao, Changqing Li
 Department of Oncology Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China 

Corresponding author at: Department of Oncology Interventional Radiology, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Road, Beijing, 100015, China.Department of Oncology Interventional RadiologyBeijing Ditan HospitalCapital Medical UniversityNo. 8 Jingshundong RoadBeijing100015China
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 27 October 2020

Highlights

59.4% unresectable HCC patients had successful down-staging after DEB-TACE, and followed radical treatment reached CR of 81.3%.
CNLC stage (IIb vs. IIa) was an independent factor for non-successful down-stating in unresectable HCC patients.
Successful down-staging was correlated with longer PFS and OS, and was an independent factor for increased OS in unresectable HCC patients.

Le texte complet de cet article est disponible en PDF.

Abstract

Background

This study aimed to investigate the potential of drug-eluting bead transarterial chemoembolization (DEB-TACE) as downstaging therapy for subsequent radical treatment in patients with hepatocellular carcinoma (HCC).

Methods

Totally, 32 patients with unresectable HCC were enrolled, then they received DEB-TACE for down-staging therapy followed by radical treatments (surgery, radiofrequency ablation or microwave ablation). The rate of successful down-staging, treatment response (after DEB-TACE and radical therapy), alpha-fetoprotein (AFP), progression-free survival (PFS) and overall survival (OS) were assessed.

Results

After down-staging therapy with DEB-TACE, successful down-staging rate was 59.4%. With the followed radical treatment, the complete response was 81.3%. Subsequent analysis indicated that CNLC stage (IIb vs. IIa) was an independent risk factor for successful down-staging. Furthermore, AFP level presented a declined trend throughout the time points (before DEB-TACE, after DEB-TACE, and after radical treatment). Additionally, 1-year, 2-year and 3-year accumulating PFS were 68.8%, 40.6% and 31.3%, respectively; 1-year, 2-year and 3-year accumulating OS were 84.4%, 71.9% and 53.1%, respectively. Kaplan-Meier curves exhibited that successful down-staging was correlated with longer PFS and OS, then further Cox’s regression analysis verified that successful down-staging was an independent factor for predicting increased OS but not PFS. Besides, child-Pugh stage (B vs. A), CNLC stage (IIb vs. IIa) and AFP abnormal after radical treatment were independent factors for decreased PFS or OS.

Conclusions

DEB-TACE has potential as an additionally effective down-staging therapy for radical treatments, and successful down-staging treatment by DEB-TACE associates with favorable survival profiles in patients with unresectable HCC.

Le texte complet de cet article est disponible en PDF.

Abbreviations : HCC, RFA, MWA, TACE, TACI, PEI, cTACE, DEB, CNLC, BCLC, PTA, AFP, PS, MRI, CR, CT, PR, SD, PD, ORR, DCR, SD

Keywords : Hepatocellular carcinoma, Drug-eluting bead transarterial chemoembolization, Down-staging, Treatment response, Survival profiles


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© 2020  The Authors. Publié par Elsevier Masson SAS. Tous droits réservés.
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