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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Comparison of ethanol-soaked gelatin sponge and microspheres for hepatic arterioportal fistulas embolization in hepatic cellular carcinoma
Guang-Sheng Yuan, Li-Li Zhang, Zi-Tong Chen, Cun-Jing Zhang, Shu-Hui Tian, Ming-Xia Gong, Peng Wang, Lei Guo, Nan Shao, Bin Liu
Guang-Sheng Yuan, Ming-Xia Gong, Nan Shao, Institute of Interventional Oncology, Shandong University, Jinan 250033, Shandong Province, China; Department of Radiology, Dongying Traditional Chinese Medicine Hospital, Dongying 257055, Shandong Province, China
Li-Li Zhang, Department of Gastroenterology, People's Hospital of Qihe County, Dezhou 251100, Shandong Province, China
Zi-Tong Chen, Shu-Hui Tian, Bin Liu, Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China; Institute of Interventional Oncology, Shandong University, Jinan 250033, Shandong Province, China
Cun-Jing Zhang, Dean’s Office, Jinan Vocational College of Nursing, Jinan 250100, Shandong Province, China
Peng Wang, Department of Interventional Medicine, People’s Hospital of Zouping City, Binzhou 256299, Shandong Province, China
Lei Guo, Department of Vascular Anomalies and Interventional Radiology, Qilu Children’s Hospital of Shandong University, Jinan 250022, Shandong Province, China
Author contributions: Yuan GS and Zhang LL have contributed equally to this work; Yuan GS and Liu B performed the conception and design; Guo L and Liu B contributed to the administrative support; Zhang LL, Chen ZT, and Zhang CJ performed the provision of study materials and patients; Chen ZT, Tian SH, Gong MX, Wang P, Guo L, and Shao N performed the data collection and assembly; Chen ZT and Zhang CJ contributed to the data analysis and interpretation; All authors wrote the manuscript and performed the final approval of manuscript.
Supported by National Natural Science Foundation of China, No. 12171285 and No. 11971269; Program for Integrated Traditional Chinese and Western Medicine in Shandong Province of China, No. YXH2019ZXY007; and Jinan New Support Projects for Universities (Talent Development Special Fund), No. 20228118.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Second Hospital of Shandong University (KYLL-2020 [LW] 23).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. Moreover, the article is distributed in accordance with the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Bin Liu, MD, Professor, Researcher, Department of Interventional Medicine, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan 250033, Shandong Province, China. gordon0221@sdu.edu.cn
Received: June 1, 2023
Peer-review started: June 1, 2023
First decision: July 17, 2023
Revised: July 24, 2023
Accepted: August 18, 2023
Article in press: August 18, 2023
Published online: September 15, 2023
BACKGROUND
Hepatic arterioportal fistulas (APFs) are common in hepatocellular carcinoma (HCC). Moreover, correlated with poor prognosis, APFs often complicate anti-tumor treatments, including transarterial chemoembolization (TACE).
AIM
To compare the efficacy of ethanol-soaked gelatin sponges (ESG) and microspheres in the management of APFs and their impact on the prognosis of HCC.
METHODS
Data from patients diagnosed with HCC or hepatic APFs between June 2016 and December 2019 were retrospectively analyzed. Furthermore, APFs were embolized with ESG (group E) or microspheres (group M) during TACE. The primary outcomes were disease control rate (DCR) and objective response rate (ORR). The secondary outcomes included immediate and first follow-up APF improvement, overall survival (OS), and progression-free survival (PFS).
RESULTS
Altogether, 91 participants were enrolled in the study, comprising 46 in group E and 45 in group M. The DCR was 93.5% and 91.1% in groups E and M, respectively (P = 0.714). The ORRs were 91.3% and 66.7% in groups E and M, respectively (P = 0.004). The APFs improved immediately after the procedure in 43 (93.5%) patients in group E and 40 (88.9%) patients in group M (P = 0.485). After 2 mo, APF improvement was achieved in 37 (80.4%) and 33 (73.3%) participants in groups E and M, respectively (P = 0.421). The OS was 26.2 ± 1.4 and 20.6 ± 1.1 mo in groups E and M, respectively (P = 0.004), whereas the PFS was 16.6 ± 1.0 and 13.8 ± 0.7 mo in groups E and M, respectively (P = 0.012).
CONCLUSION
Compared with microspheres, ESG embolization demonstrated a higher ORR and longer OS and PFS in patients of HCC with hepatic APFs.
Core Tip: Hepatocellular carcinoma (HCC) was considered the seventh most common cancer and the second leading cause of cancer-related deaths worldwide in 2020. Hepatic arterioportal fistulas (APFs) are common in HCC and often complicate anti-tumor treatments, including transarterial chemoembolization. The ethanol-soaked gelatin sponge combined the advantages of alcohol and gelatin sponges, contributed to better local control of hepatic APFs, and improved the survival of patients with HCC.
