Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.687
Peer-review started: January 17, 2023
First decision: March 1, 2023
Revised: March 9, 2023
Accepted: March 23, 2023
Article in press: March 23, 2023
Published online: April 27, 2023
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.
To investigate the efficacy and safety of hepatic TACE and TARE in advanced descending hepatectomy.
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.
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).
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.
Core Tip: The transarterial radioembolization (TARE) technique treats hepatocellular carcinoma (HCC) by perfusing radionuclide microspheres into the HCC lesion through the hepatic arterial route and releasing ionizing radiation through the radionuclide carried by the microspheres. With the development of materials science, stable radionuclide microspheres have been widely applied in clinical practice. On this basis, we found that the combined effect of transarterial chemoembolization and TARE techniques could increase the inactivation of HCC lesions, expand the scope of tumor necrosis, increase postoperative survival rate, and improve the life quality of patients. It has high clinical value in the descending treatment of patients with HCC.
- Citation: Feng R, Cheng DX, Song T, Chen L, Lu KP. Efficacy and safety analysis of transarterial chemoembolization and transarterial radioembolization in advanced hepatocellular carcinoma descending hepatectomy. World J Gastrointest Surg 2023; 15(4): 687-697
- URL: https://www.wjgnet.com/1948-9366/full/v15/i4/687.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v15.i4.687
Hepatocellular carcinoma (HCC), as a common malignant tumor, has been one of the leading causes of cancer-related death worldwide[1]. As for the prevalence of the hepatitis B virus, patients with HCC are more common in China[2]. Currently, clinical surgical treatment including hepatectomy and liver transplantation is the most effective treatment for patients with HCC to achieve long-term survival or even a radical cure[3]. However, many patients with liver cancer are diagnosed in the middle and advanced stages. Due to factors such as large tumors and large vascular accumulation, surgical resection is not possible, resulting in missed optimal timing of treatment and increased mortality from liver cancer[4]. Therefore, how to transform inoperable intermediate and advanced HCC into surgically resectable is one of the research hotspots in recent years.
The post-descending resection of HCC refers to the conversion of initially advanced liver cancer into relatively early liver cancer through local, systemic, or comprehensive therapy, so that some HCCs are converted from unresectable to resectable. The aims of descending HCC treatment are the disappearance of intrahepatic and extrahepatic parts of the tumor, the reduction of the giant tumor, the disappearance of the venous cancer thrombus, or the compensatory enlargement of the uninvaded liver[5,6]. It has been reported that the current treatment methods for HCC mainly include TACE, comprehensive hepatic artery ligation, transarterial radioembolization (TARE), and comprehensive therapy[7,8]. TACE, as the most widely used non-surgical treatment, could embolize the arterial blood supply of tumors, reduce tumor load and delay tumor progression[9]. The TARE technique, which combines embolic substances with radioactive substances to embolize the corresponding lesion through a catheter, has great potential in reducing total body irradiation and reducing effects on healthy livers[10]. Previous studies have shown that TACE, as a more effective and less invasive non-surgical treatment option, has become an important tool for adjuvant therapy. However, it has also been reported that the long-term effect of TACE alone is not significant[11,12]. Based on this, the study retrospectively analyzed the clinical data of patients with intermediate and advanced HCC and investigated the efficacy and safety of TACE alone and TACE combined with TARE in the treatment of patients with intermediate and advanced HCC, hoping to provide a more effective basis for the second surgical resection of patients with mid and advanced liver cancer.
A total of 218 patients with moderately advanced HCC admitted to Zhejiang Provincial People’s Hospital from May 2016 to May 2021 were selected for the study, including 111 males and 107 females, aged 28-77 years. According to Child-Pagh liver function rating criteria[13,14], 68 cases were grade A, 102 cases were grade B, and 48 cases were grade C. The tumor diameter ranged from 2.5 to 17.6 cm, with 90 cases with tumor diameters less than 5 cm, and 128 cases with diameters greater than 5 cm. All subjects had voluntarily signed informed consent. The 119 patients treated with TACE alone were classified as the control group. 99 patients treated with TACE combined with TARE were classified as the observation group. The control group was treated with the modified Seldinger puncture and catheterization, while the observation group was treated with hepatic arterial chemoembolization followed by high-energy X-ray arterial radioembolization combination therapy.
There was no significant difference in general data among the groups (P > 0.05). The data were comparable, as shown in Table 1.
| TACE group (n = 119) | TACE + TARE group (n = 99) | χ2 | P value | |
| Gender | 0.512 | 0.604 | ||
| Male | 63 | 48 | ||
| Female | 56 | 51 | ||
| Age (yr), mean ± SD | 56.78 ± 5.68 | 55.89 ± 5.45 | 1.173 | 0.242 |
| Child-Pagh liver function rating | 0.463 | 0.765 | ||
| Grade A | 36 | 32 | ||
| Grade B | 60 | 42 | ||
| Grade C | 23 | 25 | ||
| Tumor diameter | 0.862 | 0.755 | ||
| < 5 cm | 48 | 42 | ||
| < 5 cm | 71 | 57 |
Inclusion criteria: (1) Patients with HCC who met the diagnostic criteria of HCC in the diagnosis and treatment criteria of liver cancer[15]; (2) Patients without any other relevant treatment before TACE or TACE + TARE treatment; (3) Patients treated with TACE alone or TACE combined with TARE after TACE; (4) All patients were diagnosed by imaging examination [such as computed tomography (CT), ultrasound, magnetic resonance, etc.] combined with tumor markers and other tests to confirm the diagnosis; and (5) All patients were with advanced HCC or unable or unwilling to undergo surgery due to other reasons (tumor location, severe liver cirrhosis, old age, cardiopulmonary insufficiency, etc.).
Exclusion criteria: (1) Patients with severe heart, brain, or kidney diseases; (2) Patients with incomplete clinical data, imaging data, relevant laboratory test results or those who cannot be followed up; and (3) Patients with severe mental illness and mental retardation that could not cooperate with the treatment.
The control group was treated with TACE using a modified Seldinger puncture placement method[16,17].
All procedures were performed by the right femoral artery, and the superior mesenteric and celiac arteriography were examined by DSA. The size, structure, and course of the hepatic artery tumor were observed. Perfusion chemotherapy was administered first with 5-FU (1-1.5 g), Cisplatin (40-50 mg), and Adriamycin (40-50 mg) every 4 wk for 3 times, followed by iodinated oil (15-20 mL) pills.
The observation group was treated with TACE combined with TARE. First, interventional therapy was performed by the above method, with an interval of 4-6 wk between interventions. The radiation therapy was performed after or between interventions, with a general interval of 3-5 wk between interventions and radiation therapy. The methods and doses of radiotherapy were as follows: high-energy X-ray (18 mV) was used[18]. Local field radiation was used for liver lesions within 10 cm in diameter, with a field of 12 cm × 12 cm or less, and 160 CGy-200 CGy/d for both fields. The whole liver or sub-total liver moving strip irradiation was performed for liver lesions beyond 10 cm. Among the 99 cases in the observation group, 58 cases had focal field radiation of liver tumor, completing 3800 CGy of tumor irradiation. 41 cases had 4 rounds of whole liver mobile strip radiation, completing 2200-3000 CGy of liver central plane dose. Patients were given oxygen during the operation, their vital signs were monitored, and food rich in vitamins and high protein was given after the operation.
Lesion inactivation: According to World Health Organization objective efficacy criteria[19,20]: complete remission (CR): the lesions disappeared completely and are maintained for more than one month; partial remission (PR): the two diameters of the lesion were reduced by more than 50% and the maintenance lasted for more than one month; nature change: the lesions were reduced less than 50% or enlarged less than 25% and maintained for more than one month; progress development: the lesions were enlarged by more than 25% or new lesions appeared. Blood routine examination was performed once a week during the treatment period, and liver CT was repeated every 3 mo to evaluate the efficacy and calculate the effective rate (Figure 1A and B). The effective treatment rate = (CR + PR) × 100%.
Tumor nodules: During the treatment period, the patients were treated with immune enhancement and liver protection. After the treatment, the liver and kidney functions were reexamined. After 2 mo, the CT imaging changes were observed to detect the tumor nodule size.
Deposition of lipiodol: Patients with HCC could be treated with lipiodol interventional embolization, which is based on the principle that lipiodol binds more strongly to hepatocellular tumor cells than hepatocytes. The higher the lipiodol filling density, the greater the degree of the deposition, the greater and more complete the degree of tumor necrosis, and its contraction is more obvious, thus prolonging the survival of patients. According to the amount of lipiodol in tumor tissue, there are 5 grades[21]: Grade 0 (without lipiodol deposition), Grade I (lipiodol retention in lesions < 10%), Grade II (< 50%), Grade III (> 50%), and Grade IV (the whole lesion is full of iodine oil). The deposition of lipiodol in patients was observed according to the above standards.
Serum alpha-fetoprotein level in different periods: After treatment, the levels of liver function, kidney function, and blood routine were reexamined. Serum alpha-fetoprotein (AFP) levels in the control group and observation group were observed in different periods, such as 1 mo, 3 mo, 6 mo, and 1 year after the operation.
Postoperative complications and 1-year survival rate: After the treatment, the incidence of complications such as postoperative fever, pleural effusion, cholecystitis, and hepatic encephalopathy was observed in the control group and the observation group, and the 1-year survival rate was statistically analyzed and compared between the two groups.
Clinical symptoms and adverse reactions of patients: Clinical symptoms include liver pain, fatigue, abdominal distension, and so on. Scoring standard[22]: no symptoms-0 points; occasional symptoms-1 point; frequent symptoms-2 points; symptoms persist for a long time and affect daily activities-3 points. Adverse reactions mainly include nausea, vomiting, hair loss, and so on.
All data were processed and analyzed using SPSS 21.0 software. The measurement data was expressed as mean ± SD, the comparison between groups was analyzed by t-test, the counting data were expressed as n (%), and the comparison was analyzed by χ2 test. All the differences were statistically significant at P < 0.05.
By observing the inactivation of lesions treated with different interventions in the two groups, we found that both the TACE group and TACE + TARE group had better treatment effective rate (CR + PR), and the effective rate of the TACE + TARE group (68.69%) was higher than that of the TACE group (42.86%). The levels of CR and PR in the TACE + TARE group were significantly different from those in the TARE group (P < 0.05). The results showed that TACE + TARE combined intervention therapy has significantly higher therapeutic efficiency and better efficacy than TACE alone (Table 2).
| Group | CR | PR | NC | PD | The effective rate of treatment |
| TACE group (n = 119) | 25 (21.01) | 26 (21.84) | 38 (26.89) | 30 (18.49) | 51 (42.86) |
| TACE + TARE group (n = 99) | 34 (34.34) | 34 (34.34) | 16 (21.21) | 15 (23.23) | 68 (68.69) |
| χ2 | 0.040 | 0.057 | 0.011 | 0.097 | < 0.001 |
| P value | 0.027 | 0.040 | 0.007 | 0.068 | < 0.001 |
Further observation of the size of tumor nodules in the two groups of patients with different intervention treatments showed that the size of tumor nodules in the TACE group and TACE + TARE group were reduced to some extent. In TACE + TARE group, the tumor nodules were less than 50% or stable at 73.74%, which was better than that of the TACE group (47.89%). In the TACE + TARE group, the tumor nodules decreased significantly compared with the TACE group, and the difference was statistically significant (P < 0.05). The results indicated that TACE + TARE combination treatment could reduce tumor nodule size and inhibit cancer progression compared with TACE alone (Table 3).
| Group | Tumor nodules | |||
| > 50% | < 50% | Stable | Increase | |
| TACE group (n = 119) | 39 (32.78) | 28 (23.53) | 29 (24.37) | 23 (19.33) |
| TACE + TARE group (n = 99) | 20 (20.20) | 36 (36.36) | 37 (37.37) | 6 (6.06) |
| χ2 | 0.054 | 0.041 | 0.053 | 0.008 |
| P value | 0.038 | 0.028 | 0.037 | 0.004 |
One month later, CT was reexamined to observe the deposition of lipiodol in all cases. The deposition of lipiodol to grade III-IV in the TACE + TARE group (63.64%) was significantly better than that in TACE alone (48.74%) (P < 0.05), which indicated that the combination treatment of TACE + TARE could significantly increase lipiodol deposition and enlarge tumor necrosis compared with TACE alone (Table 4).
| Group | Lipiodol deposition | |||||
| Grade 0 | Grade I | Grade II | Grade III | Grade IV | Grade III + IV | |
| TACE group (n = 119) | 18 (29.41) | 23 (29.41) | 20 (21.85) | 30 (25.21) | 28 (23.53) | 58 (48.74) |
| TACE + TARE group (n = 99) | 8 (29.41) | 8 (11.11) | 10 (15.15) | 38 (38.38) | 35 (35.35) | 63 (63.64) |
| χ2 | 0.165 | 0.030 | 0.152 | 0.037 | 0.045 | < 0.001 |
| P value | 0.110 | 0.018 | 0.217 | 0.052 | 0.077 | < 0.001 |
AFP is an acidic glycoprotein, which exists in the liver and yolk sac at the early stage of fetal development, and gradually disappears shortly after birth. The content of normal people is extremely low, and when the content is significantly increased, it helps in the diagnosis of primary liver cancer[23,24]. The results of this study showed that the AFP levels in both groups decreased after the operation, but the AFP levels of the TACE + TARE group were significantly lower than those of the control group in each period after the operation (P < 0.05), which indicated that the combined therapy had a better effect (Table 5).
| Group | AFP (μg/L) | |||
| 1 mo after the operation | 3 mo after the operation | 6 mo after the operation | 1 year after the operation | |
| TACE group (n = 119) | 38.33 ± 4.78 | 38.67 ± 5.32 | 36.45 ± 3.24 | 31.53 ± 3.54 |
| TACE + TARE group (n = 99) | 36.45 ± 5.68 | 35.53 ± 4.45 | 32.37 ± 3.47 | 28.78 ± 3.25 |
| χ2 | 2.654 | 4.669 | 8.963 | 5.926 |
| P value | 0.009 | < 0.001 | < 0.001 | < 0.001 |
Postoperative complications and 1-year survival were compared between the TACE + TARE group and the control group. The total incidence of fever, cholecystitis, ascites and hepatic encephalopathy in the TACE + TARE group (36.37%) was higher than that in the TACE group (34.45%), but the difference was not statistically significant (P > 0.05). In addition, the 1-year survival rate of the TACE + TARE group was significantly higher than that of the TACE group (P < 0.05). The above results indicated that TACE + TARE combined therapy had better safety, and TACE + TARE combined therapy could better improve the 1-year survival rate of patients (Table 6).
| Complications | TACE group (n = 119) | TACE + TARE group (n = 99) | χ2 | P value |
| Fever | 6 (5.04) | 6 (6.06) | 0.976 | 0.743 |
| Hydrothorax | 16 (13.45) | 15 (5.05) | 0.869 | 0.720 |
| Cholecystitis | 4 (3.36) | 6 (6.06) | 0.533 | 0.343 |
| Hepatic encephalopathy | 15 (12.61) | 9 (9.09) | 0.543 | 0.409 |
| Total complication rate | 41 (34.45) | 36 (36.37) | 0.880 | 0.769 |
| 1-yr survival rate | 25 (21.00) | 33 (33.33) | 0.058 | 0.040 |
Clinical symptoms such as pain in the liver area, weakness, and abdominal distension were observed in each group. It was found that there was no significant difference in clinical symptom scores between the TACE group and TACE + TARE group before treatment (P > 0.05). After treatment, the scores of clinical symptoms in the TACE + TARE group were significantly lower than those in the control group (P < 0.05). In addition, the overall incidence of adverse reactions such as nausea, vomiting, and alopecia in the TACE group was 25.21%, and that in the TACE + TARE group was 14.14%. The data showed that the overall incidence of adverse reactions in the TACE + TARE group was lower than that in the TACE group, and the difference was statistically significant (P < 0.05), which indicated TACE alone or combined with TARE had a higher therapeutic effect and better safety on clinical symptoms such as liver pain, fatigue, and abdominal distension in patients with advanced HCC (Tables 7 and 8).
| Group | Hepatic pain | Fatigue | Abdominal distension | |||
| Before treatment | After treatment | Before treatment | After treatment | Before treatment | After treatment | |
| TACE group (n = 119) | 2.31 ± 0.56 | 2.07 ± 0.63 | 2.67 ± 0.87 | 2.35 ± 0.54 | 2.93 ± 0.62 | 2.37 ± 0.55 |
| TACE + TARE group (n = 99) | 2.29 ± 0.58 | 1.56 ± 0.72 | 2.54 ± 0.58 | 1.45 ± 0.63 | 2.79 ± 0.58 | 1.26 ± 0.66 |
| χ2 | 0.258 | 5.576 | 0.720 | 11.357 | 1.709 | 13.545 |
| P value | 0.796 | < 0.05 | 0.205 | < 0.001 | 0.089 | < 0.001 |
| Group | Nausea | Vomiting | Hair loss | Total incidence |
| TACE group (n = 119) | 11 (9.24) | 9 (7.56) | 10 (8.40) | 30 (25.21) |
| TACE + TARE group (n = 99) | 5 (5.05) | 5 (5.05) | 4 (4.04) | 14 (14.14) |
| χ2 | 0.357 | 0.634 | 0.303 | 0.063 |
| P value | 0.237 | 0.451 | 0.191 | 0.043 |
Clinically, HCC is considered to be a malignant tumor of the digestive system with a high incidence. However, most patients have an insidious condition and are diagnosed in the middle and advanced stages, therefore, interventional surgery has become an important option[25-27]. With the continuous application of combined technology in clinical application, TACE combined with TARE technology has better efficacy in patients with mid or advanced HCC[8,10]. Since Goldstein first reported the treatment of HCC with TACE in 1976, TACE has been rapidly developed and further developed worldwide[11,28]. TACE is mainly suitable for patients with unresectable HCC and well liver function, and its efficacy is positive, which can improve the survival rate of HCC patients in this stage[2,29-31]. However, TACE is difficult to achieve a radical cure of cancer due to factors such as ectopic blood supply, angiogenesis, and portal vein blood supply around the tumor, and the tumor control rate of TACE alone is only about 20%[32,33]. Therefore, comprehensive treatment based on TACE has become a research hotspot in recent years. By analyzing the clinical efficacy of TACE alone and TACE + TARE combined therapy, the study aims to provide some data support for the treatment of advanced HCC patients.
The TARE technique involves the infusion of radionuclide microspheres into HCC lesions through hepatic artery access, and the ionizing radiation is released through the nuclide carried by the microspheres to treat HCC[34-38]. Meanwhile, radiotherapy has a wide range of applications, which are not limited by anatomical location and tumor localization. However, it is found that radiotherapy alone is difficult to achieve effective radiation doses for some tumors, and some HCC patients are insensitive to radiotherapy. In addition, the production of radioactive microspheres is expensive, which undoubtedly increases the economic burden of patients to a certain extent[39,40]. Therefore, the combination of TARE with other methods is one of the mainstream trends. On this basis, this study aimed to investigate the clinical efficacy and related adverse reactions of TACE + TARE in the treatment of advanced HCC patients, hoping to provide some help for the prevention and treatment of advanced HCC.
In this study, 99 patients with intermediate or advanced HCC were treated with TACE + TARE, and 119 patients with intermediate or advanced HCC were treated with TACE as the control. The lesion inactivation, tumor nodule size, and serum AFP level in different periods were compared between the observation group and the control group to observe the efficacy of TACE and TARE combined treatment. The results showed that the effective rate of TACE + TARE combined therapy was significantly increased and the tumor nodule size was significantly reduced compared with TACE alone group. This suggests that combination therapy could significantly improve the therapeutic effect and inhibit the malignant progression of the tumor.
It has been reported that the higher the density and range of lipiodol filling, the more deposition, the larger and more complete the range of tumor necrosis, and the more obvious the reduction, thus prolonging the survival time of HCC patients[21]. The results of this study showed that the degree of lipiodol deposition to grade III to IV in the TACE + TARE group was significantly better than that in the TACE group, which indicated that the synergistic effect of the TACE + TARE group could expand the range of tumor necrosis, reduce the tumor area and enhance the therapeutic effect. In addition, the study also found that there was no significant difference in postoperative complications such as fever, and cholecystitis ascites in the TACE group, and the one-year survival rate of the TACE + TARE group was higher than that of the TACE group. Meanwhile, after treatment, the scores of clinical symptoms such as liver pain, fatigue, and abdominal distension in the TACE + TARE group were significantly lower than those in the TACE group. In addition, the overall incidence of adverse reactions in the TACE + TARE group was lower than that in the TACE group. All the above results indicated that TACE + TARE therapy had higher clinical efficacy and better safety in patients with advanced HCC than TACE alone.
In recent years, more and more studies tend to combine TACE with TARE. Kim et al[32] found through Meta-analysis results that TACE combined with radiotherapy was superior to TACE alone in terms of short-term efficacy (CR + PR) remission rate and long-term 1-, 2- and 3-year survival time. In addition, Currie et al[41] also reported that TACE alone combined with interventional chemoembolization and radiotherapy could reduce normal liver tissue damage, improve tumor control rate and prolong patient survival time. Also, TACE combined with radiotherapy was significantly better than TACE alone in reducing recurrence rate and metastasis rate[42]. The above study further confirmed the conclusion of this study that compared with TACE alone, TACE combined with TARE could have a better therapeutic effect and clinical value with better safety for patients with advanced HCC. This will provide evidence for the treatment of patients with advanced HCC and provide the possibility for their secondary operation.
However, due to the limitation of sample quantity, the actual efficacy in the clinical application needs to be further verified, and we will discuss it in depth in the future.
In conclusion, TACE combined with TARE could increase the inactivation of HCC lesions, reduce tumor nodules, expand tumor necrosis range, increase postoperative survival rate, reduce postoperative adverse reactions and improve the survival quality of patients, which have high clinical value and better safety in the descending treatment of patients with advanced HCC.
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver. Transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) is the recommended treatment for intermediate HCC according to the Barcelona Clinic Liver Cancer guidelines.
TARE, as a new interventional therapy, has been gradually applied to the treatment of advanced HCC, and has a good effect on the treatment of advanced HCC.
To explore the efficacy and safety of TACE+TARE in the advanced HCC descending hepatectomy.
The patients in the control group and the observation group were compared in terms of focal inactivation, tumor nodule size, lipiodol deposition, serum alpha-fetoprotein (AFP) level in different periods, postoperative complications, 1-year survival rate, and adverse reactions.
Compared with the control group, the observation group can be effective, reduce tumor nodules, reducing postoperative AFP value, reducing postoperative complications, and relieving clinical symptoms. Compared with the control group, the observation group significantly increased the deposition of lipiodol, expanded the scope of tumor necrosis, increased the 1-year survival rate of patients after surgery, and reduced adverse reactions, the difference was statistically significant (P < 0.05).
Compared with TACE, TACE + TARE is more effective in the treatment of patients with advanced HCC.
This study may provide a clinical basis for the treatment of patients with advanced HCC.
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Gastroenterology and hepatology
Country/Territory of origin: China
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P-Reviewer: Abe K, Japan; Mahmud N, United States S-Editor: Gong ZM L-Editor: A P-Editor: Gong ZM
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