Published online Sep 15, 2023. doi: 10.4251/wjgo.v15.i9.1595
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
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).
To compare the efficacy of ethanol-soaked gelatin sponges (ESG) and micro
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).
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).
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.