Comparison of transcatheter arterial chemoembolization and transcatheter arterial chemotherapy infusion for patients with intermediate-stage hepatocellular carcinoma

The clinical efficacy and safety of TACE combined with apatinib for advanced hepatocellular carcinoma: A propensity score matching analysis

Background

The combined treatment of transcatheter arterial chemoembolization (TACE) and apatinib had beneficial effects on the survival of patients with advanced hepatocellular carcinoma (HCC), but the efficacy of this regimen is still controversial and needs further investigation.

Materials and Methods

The clinical records of advanced HCC patients between May 2015 and December 2016 were collected from our hospital. They were categorized into the TACE monotherapy group and the combination of TACE and apatinib group. After propensity score matching (PSM) analysis, the disease control rate (DCR), objective response rate (ORR), progression-free survival (PFS), and occurrence of adverse events were compared between the two treatments.

Results

There were 115 HCC patients included in the study. Among them, 53 received TACE monotherapy and 62 were treated with TACE plus apatinib. After PSM analysis, 50 pairs of patients were compared. The DCR of the TACE group was significantly lower than that of the combination of TACE and apatinib group (35 [70%] versus 45 [90%], P < 0.05). The ORR of the TACE group was also significantly lower than that of the combination of TACE and apatinib group (22 [44%] versus 34 [68%], P < 0.05). Patients who received the combined treatment of TACE and apatinib had longer PFS compared with those in the TACE monotherapy group (P < 0.001). Moreover, hypertension, hand-foot syndrome, and albuminuria were more common in the combination of TACE and apatinib group (P < 0.05), although all adverse events were well tolerated.

Conclusions

The combined treatment of TACE and apatinib showed beneficial effects on tumor response, survival outcomes, and tolerance to treatment, which may be used as a routine regimen for advanced HCC patients.

Loco-Regional Treatments for Hepatocellular Carcinoma in People Living with HIV

Hepatocellular carcinoma (HCC) accounts for approximately 75–90% of primary liver cancers and is the sixth most common cancer and the third leading cause of cancer-related deaths worldwide. In the HIV-positive population, the risk of HCC is approximately four times higher than in the general population, with higher cancer-specific mortality than in HIV-negative patients. In most cases, HCC diagnosis is made in patients younger than the HIV-negative population and in the intermediate-advanced stage, thus limiting the therapeutic possibilities. Treatment choice in HIV-positive patients with HCC is subject to cancer staging, liver function and health status, as for HIV-negative and non-HIV-negative HCC patients. There are relatively few studies on the efficacy and safety in HIV-positive patients to date in loco-regional treatments for HCC. So far, literature shows that curative treatments such as radiofrequency ablation (RFA) have no significant differences in overall survival between HIV-positive and HIV-negative patients, as opposed to palliative treatments such as TACE, where there is a significant difference in overall survival. Although it can be assumed that the most recently discovered loco-regional therapies are applicable to HIV-positive patients with HCC in the same way as HIV-negative patients, further studies are needed to confirm this hypothesis. The purpose of our review is to evaluate these treatments, their efficacy, effectiveness, safety and their applicability to HIV-positive patients.

Preoperative Combined Prediction Models Have Superior Capability in Predicting Survival as the Child-Pugh Grade in Patients with HCC after Interventional Embolotherapy

Background

It is of important clinical significance for hepatocellular carcinoma (HCC) patients to evaluate prognosis before interventional embolotherapy.

Methods

A total of 106 patients with HCC after interventional embolotherapy who had complete data with follow-up information until September 2019 were included in this study. These data were analyzed using SPSS Version 22.0 and R (version 3.6.1) statistical software.

Results

1) The diameter of the tumor, ascites, FIT, AFP, ALT, AST, GGT, and Child-Pugh score had the ability to predict the prognosis and survival of patients with HCC. Among these molecules, the predictive effectiveness (or the area under the receiver operating characteristic [ROC] curve) of GGT was the highest, although it was slightly lower than the predictive effectiveness of the Child-Pugh score, which is the gold standard for survival analysis. 2) Among survival analyses combining five molecular indicators, the predictive postoperative viability for combination 1 was the strongest with an area under the ROC curve (AUC) of 0.856 (0.779, 0.932), similar to the all-molecular combination (combination 16) with an AUC of 0.872 (0.798, 0.945), but much higher than that of the Child-Pugh score of 0.720 (0.616, 0.823) for HCC patients (all p<0.05). 3) Kaplan-Meier analyses showed that the 3-year cumulative survival rates were 55.3% for low-risk patients and 2.6% for high-risk patients.

Conclusion

A combined prediction model can determine the optimal combination of preoperative routine detection indices in patients with HCC intervention, and ROC curve analysis can quantify the efficacy of these indices in the survival and prognosis of HCC. Interestingly, combination 1 showed stronger predictive capability than the Child-Pugh score in predicting death risks for postoperative patients with HCC. When combination 1 has several missing clinical data, these combination prediction models (12, 3, 7, 13, 16) are also a replaceable choice. These findings may have important clinical significance in the formulation of individualized medical programs.

Transarterial- chemoembolization remains an effective therapy for intermediate-stage hepatocellular carcinoma with preserved liver function

AIM

To evaluate outcomes as well as prognostic factors of transarterial chemoembolization (TACE) in intermediate-stage hepatocellular carcinoma (HCC) with preserved liver function to determine positioning of TACE.

METHODS

Of 158 treatment-naïve patients with intermediate-stage HCC who received initial TACE from February 2007 to January 2016, 113 patients met the following inclusion criteria: no combined therapy within 4 weeks after initial TACE, and Child-Pugh score under 7. Response rate and overall survival were evaluated. The prognostic factors were investigated in univariate and multivariate analyses using Cox proportional hazards models. The deterioration of liver function after repeated TACE was also evaluated.

RESULTS

The response rate was 92.7% (complete response, 63.3%; partial response, 29.4%). The median survival time was 45.2 months. Survival rates at 1, 2, and 3 years were 90.4%, 77.0%, and 60.8% respectively. Age ≥ 75 years (P = 0.022), serum α-fetoprotein level ≥ 200 ng/mL (P = .010), tumor number ≥ 11 (P = 0.008), and heterogeneous enhancement on dynamic computed tomography (P = 0.024) were poor prognostic factors. The deterioration rate of Child-Pugh score and albumin-bilirubin grade was 18.5% and 12.3%, respectively, after the first TACE, 15.6% and 5.1%, respectively, after the second TACE, and 14.5% and 11.1%, respectively, after the third TACE.

CONCLUSION

Superselective TACE can achieve high tumor response rates with prolonged overall survival for patients with intermediate-stage HCC with preserved liver function. Age, serum α-fetoprotein level, tumor number ≥ 11, and heterogeneous enhancement on dynamic computed tomography indicated significantly poor prognosis.

Prognostic value of des-γ-carboxy prothrombin in patients with hepatocellular carcinoma treated with transarterial chemotherapy: A systematic review and meta-analysis

BACKGROUND

Serum des-γ-carboxy prothrombin (DCP) is a hepatocellular carcinoma (HCC) tumor marker that can be used to assess patient prognosis. Since the value of DCP in predicting the prognosis of hepatocellular carcinoma patients treated with transarterial chemotherapy remains controversial, we performed a meta-analysis of previous clinical studies.

METHODS

A systematic literature search was performed using PubMed, the MEDLINE database, EMBASE, and the Cochrane Library in accordance with the PRISMA guidelines. The hazard ratio (HR) with 95% confidence interval (CI) was used to estimate the effect size.

RESULTS

Six respective cohort studies including a total of 943 cases were identified. The pooled results showed that low DCP was associated with a favorable overall survival (OS)(HR 0.653, 95% CI 0.444-0.960), and DCP response was associated with increased OS (HR 0.387,95% CI 0.215-0.697) and progression-free survival (PFS) (HR 0.42,95% CI 0.23-0.74) in HCC patients treated with transarterial chemotherapy.

CONCLUSIONS

DCP values in HCC patients undergoing hepatic arterial chemotherapy seem to be associated with OS and PFS. Thus, monitoring DCP values and observing the DCP response should be part of the management of patients undergoing transarterial chemotherapy.

Liver resection versus transarterial chemoembolization for the treatment of intermediate-stage hepatocellular carcinoma

BACKGROUND

The role of transarterial chemoembolization (TACE) as the standard treatment for intermediate-stage hepatocellular carcinoma (HCC) is being challenged by increasing studies supporting liver resection (LR); but evidence of survival benefits of LR is lacking. We aimed to compare the overall survival (OS) of LR with that of TACE for the treatment of intermediate-stage HCC in cirrhotic patients.

METHODS

A Markov model, comparing LR with TACE over 15 years, was developed based on the data from 31 literatures. Additionally, external validation of the model was performed using a data set (n = 1735; LR: 701; TACE: 1034) from a tertiary center with propensity score matching method. We conducted one-way and two-way sensitivity analyses, in addition to a Monte Carlo analysis with 10 000 patients allocated into each arm.

RESULTS

The mean expected survival times and survival rates at 5 years were 77.8 months and 47.1% in LR group, and 48.6 months and 25.7% in TACE group, respectively. Sensitivity analyses found that initial LR was the most favorable treatment. The 95% CI for the difference in OS was 2.42-2.46 years between the two groups (P < 0.001). In the validation set, the 5-year survival rates after LR were significantly better than those after TACE before (40.2% vs. 25.9%, P < 0.001) and after matching (43.2% vs 30.9%, P < 0.001), which was comparable to the model results.

CONCLUSIONS

For cirrhotic patients with resectable intermediate-stage HCC, LR may provide survival benefit over TACE, but large-scale studies are required to further stratify patients at this stage for different optimal treatments.

Efficacy and Safety of Transcatheter Arterial Chemoembolization and Transcatheter Arterial Chemotherapy Infusion in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Hepatocellular carcinoma (HCC) is a worldwide health threat with increasing incidence and a high mortality rate. Most HCC patients are diagnosed at an advanced stage and are unable to undergo potential curative surgery. Transcatheter arterial chemoembolization (TACE) and transcatheter arterial chemotherapy infusion (TACI) are two of the main palliative treatments for advanced HCC patients. The clinical efficacy and safety of TACE and TACI are controversial. For this reason, we conducted a systematic review and meta-analysis to summarize the current evidence. We searched for randomized controlled trials (RCTs) and cohort studies that compared the clinical outcomes and adverse effects in HCC patients who received TACE or TACI treatments. The database search was performed and last updated on November 1, 2016. Overall survival and clinical response were compared using a hazard ratio (HR) with a 95% confidence interval (CI). A total of 11 clinical studies that included 13,090 patients were included based on the inclusion/exclusion criteria, of which 9 were cohort studies and 2 were RCTs. TACE was associated with a 23% lower hazard of death compared to TACI (pooled HR = 0.77, 95% CI = 0.67–0.88, p = 0.0002). Patients receiving TACE had a 28% higher disease control rate (DCR) and 162% higher objective response rate (ORR). Only the increase in ORR associated with TACE was statistically significant [DCR: odds ratio (OR) = 1.28, 95% CI = 0.35–4.64, p = 0.71; ORR: OR = 2.62, 95% CI = 1.33–5.15, p = 0.002]. TACE is associated with more favorable survival and response rate than TACI in patients with intermediate or advanced HCC.

Transarterial Infusion Chemotherapy With and Without Embolisation in Hepatocellular Carcinoma Patients: A Systematic Review and Meta-Analysis

Introduction: The purpose of this meta-analysis was to compare the efficacy of transarterial chemoembolisation (TACE) and iodised oil infusion chemotherapy without embolisation (TAI) in patients with hepatocellular carcinoma. Materials and Methods: We searched for randomised controlled trials, retrospective cohort studies, and two-arm prospective studies that compared the clinical outcomes in patients who received TACE and TAI treatment. Database search was performed through 14 December 2016. Rates of survival and therapy response were compared using odds ratios (OR) with 95% confidence intervals (CI). Results: Survival rates and therapy response rates were similar between patients who received TACE and TAI treatments (pooled OR: 1.278; 95% CI , 0.783 to 2.086, P = 0.327; and pooled OR: 1.502; 95% CI, 0.930 to 2.426, P = 0.096, respectively). Conclusion: Our results suggest that treatment intensification by adding embolisation did not increase overall survival and therapy response over TAI in patients with hepatocellular carcinoma. Key words: Liver cancer, Liver disease, Transarterial chemoembolisation

Transcatheter arterial chemoembolisation (TACE) plus S-1 for the treatment of BCLC stage B hepatocellular carcinoma refractory to TACE

AIM OF THE STUDY

To assess the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus S-1 for the treatment of Barcelona Clinic Liver Cancer (BCLC) Stage B HCC refractory to TACE.

MATERIAL AND METHODS

26 patients meeting the eligibility criteria were enrolled. TACE was given on day 1, and S-1 on days 2-15. Tumor assessment was performed one month later according to mRECIST. The primary endpoints were TTP and OS.

RESULTS

Twenty-six patients received 176 TACE interventions in all. Fifteen patients of TACE plus S-1 received a total of 55 cycles of treatment of S-1, with a median of 4 cycles (range, 2-6). The total dose of S-1 was 6165 mg per day, while average was 120 mg (range, 100-125 mg) for 15 patients of TACE plus S-1. Median TTP and OS of TACE plus S-1 were 6 months (95% CI: 4.7-7.3) and 18 months (95% CI: 15.3-24.7), respectively, while TACE monotherapy was 4 months (95% CI: 2.4-5.6) and 13 months (95% CI: 9.8-16.2), respectively, and significant differences were detected. Though there were higher DCRs in patients of TACE plus S-1, no significant differences were detected. A total of 612 adverse events occurred during the course of the treatment, 367 in TACE plus S-1 and 245 in TACE mono-therapy. There were significant differences to anorexia and nausea, but they were tolerable.

CONCLUSIONS

TACE plus S-1 in the present analysis was tolerable and associated with an interesting TTP and OS. TACE plus S-1 may be used as a new treatment method to BCLC Stage B HCC refractory to TACE.

Review on the Applications and Molecular Mechanisms of Xihuang Pill in Tumor Treatment

Xihuang pill (XH) is a complementary and alternative medicine that has been used in traditional Chinese medicine (TCM) for the treatment of tumors since the 18th century. XH has clinical effects on non-Hodgkin lymphoma, breast cancer, gastric cancer, liver cancer, and bone metastasis. XH can also inhibit the growth of tumor cells and cancer stem cells, prevent tumor invasion and angiogenesis, and regulate the tumor microenvironment. XH is composed of Ru Xiang (olibanum), Mo Yao (Commiphora myrrha), She Xiang (Moschus), and Niu Huang (Calculus bovis). Some of the compounds found in these ingredients exert multiple antitumor effects and may synergize with the other ingredients. We aimed to summarize the clinical applications and molecular mechanisms of XH and its chemical composition. This review will provide potential new strategies and alternative perspectives for tumor treatments and basic research into complementary and alternative medicine.

The predictive value of metabolic tumor volume on FDG PET/CT for transarterial chemoembolization and transarterial chemotherapy infusion in hepatocellular carcinoma patients without extrahepatic metastasis

OBJECTIVE

The aim of this study was to evaluate the prognostic value of metabolic tumor volume (MTV) on pre-treatment F-18 fluorodeoxyglucose (FDG) PET/CT in patients with hepatocellular carcinoma (HCC).

METHODS

A total of 59 HCC patients who underwent FDG PET/CT before transarterial chemoembolization (TACE) or transarterial chemotherapy infusion (TACI) were retrospectively enrolled. The region of interest was drawn in the HCC and normal liver tissue. MTV2SD, defined as the sum of the voxels with higher standardized uptake values (SUV) than the SUV of the 97.5th percentile of voxels of the normal liver for each patient, was calculated using an intensity-volume histogram (IVH). The ratio of the maximum SUV of the tumor to the mean SUV of normal liver (T max/L mean) was also calculated. The prognostic significance of MTV2SD and Tmax/Lmean for progression-free survival (PFS) and overall survival (OS) was evaluated along with other clinical factors.

RESULTS

The tumor number, Tmax/Lmean, and MTV2SD were significant prognostic factors affecting PFS (p < 0.05), whereas tumor number, serum alpha-fetoprotein level, tumor stage, portal vein thrombosis, Tmax/Lmean, and MTV2SD were significant prognostic factors for OS (p < 0.05). In multivariate analysis, the tumor number and MTV2SD were independent prognostic factors for PFS (p < 0.05), whereas the independent prognostic factors for OS were tumor number, tumor stage, and MTV2SD (p < 0.05). The mean PFS and OS in patients with low MTV2SD (15.4 and 63.1 months, respectively) were significantly longer than those in patients with high MTV2SD (6.0 and 15.2 months, respectively; p = 0.005 and p < 0.0001, respectively).

CONCLUSIONS

Metabolic tumor volume was an independent prognostic factor for PFS and OS in patients with HCC. Therefore, FDG PET/CT can provide valuable prognostic information for HCC patients who undergo TACE or TACI.