A retrospective comparative study of epirubicin-lipiodol emulsion and cisplatin-lipiodol suspension for use with transcatheter arterial chemoembolization for treatment of hepatocellular carcinoma

Transcatheter arterial chemoembolization (TACE) is widely used to treat unresectable hepatocellular carcinoma (HCC). Recently, a fine-powder formulation of cisplatin (DDP-H) was developed in Japan. We aimed to compare clinical outcomes after TACE using epirubicin or DDP-H in patients with HCC. We evaluated 202 patients who were treated with TACE alone, using either epirubicin-lipiodol emulsion or DDP-H-lipiodol suspension. Of these, epirubicin and DDP-H treatment groups comprised 106 and 96 patients, respectively. The median follow-up time was 32 months (range: 1-45 months). The progression free survival rate in the DDP-H–lipiodol group was significantly higher than in the epirubicin-lipiodol group (log-rank test, P =0.0164). Moreover, the DDP-H–lipiodol group showed significantly better overall survival than the epirubicin-lipiodol group (log-rank test: P =0.0052). The overall survival rate at 1, 2, and 3 years was 88.5, 71.8 and 62.4%, respectively, for the DDP-H-lipiodol group and 83.0, 57.9 and 36.5%, respectively, in the epirubicin-lipiodol group. In a multivariate analysis, the independent factors affecting overall survival were drug (epirubicin vs. DDP-H; hazard ratio 0.44, P= 0.0001), clinical stage (I/II vs. III/IV; hazard ratio 1.93, P = 0.0026), and Child-Pugh score (A vs. B/C; hazard ratio 3.15, P < 0.0001). TACE using a gelatin sponge and lipiodol with DDP-H showed better progression-free survival and overall survival rates than TACE with the epirubicin-lipiodol emulsion in patients with HCC. The improvement of overall survival in patients with HCC receiving this treatment warrants further investigation as a randomized control trial.