Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2024; 16(6): 2476-2486
Published online Jun 15, 2024. doi: 10.4251/wjgo.v16.i6.2476
Drug-eluting bead transarterial chemoembolization as neoadjuvant therapy pre-liver transplantation for advanced-stage hepatocellular carcinoma
Zhao-Dan Ye, Li Zhuang, Meng-Chen Song, Zhe Yang, Wu Zhang, Jing-Feng Zhang, Guo-Hong Cao
Zhao-Dan Ye, Meng-Chen Song, Guo-Hong Cao, Department of Radiology, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310022, Zhejiang Province, China
Li Zhuang, Zhe Yang, Wu Zhang, Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310022, Zhejiang Province, China
Jing-Feng Zhang, Diagnostic and Therapeutic Center for Difficult Diseases, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang Province, China
Co-corresponding authors: Jing-Feng Zhang and Guo-Hong Cao.
Author contributions: Ye ZD designed the study and wrote the manuscript; Zhuang L, Song MC, Yang Z, and Zhang W collected the patient’s clinical data; Zhang JF reviewed and edited the original draft of the manuscript; Cao GH conceptualized the study and organized the follow-up and data collection; and all authors have read and approved the final manuscript. Zhang JF and Cao GH are co-corresponding authors based upon their equal contributions in review of the manuscript for important intellectual content and provision of advice on the overall study and its construction as a peer-review publication.
Supported by Project of Medical and Health Technology Program in Zhejiang Province, No. 2020KY787.
Institutional review board statement: This study was approved by the Ethics Committee of the Institutional Review Board of Shulan (Hangzhou) Hospital (No. KY2023019).
Informed consent statement: Due to the retrospective nature of the study, written informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It 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: Guo-Hong Cao, MD, Chief Doctor, Department of Radiology, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, No. 848 Dongxin Road, Hangzhou 310022, Zhejiang Province, China. caoguohong@163.com
Received: January 29, 2024
Revised: March 17, 2024
Accepted: April 18, 2024
Published online: June 15, 2024
Processing time: 137 Days and 18.9 Hours
Abstract
BACKGROUND

The objectives of this study were to assess the safety and efficacy of drug-eluting bead transarterial chemoembolization (DEB-TACE) as neoadjuvant therapy before liver transplantation (LT) for advanced-stage hepatocellular carcinoma (HCC) and to analyze the prognostic factors.

AIM

To determine whether DEB-TACE before LT is superior to LT for advanced-stage HCC.

METHODS

A total of 99 individuals diagnosed with advanced HCC were studied retrospectively. The participants were categorized into the following two groups based on whether they had received DEB-TACE before LT: DEB-TACE group (n = 45) and control group (n = 54). The participants were further divided into two subgroups based on the presence or absence of segmental portal vein tumor thrombus (PVTT). The DEB-TACE group consisted of two subgroups: Group A (n = 31) without PVTT and group B (n = 14) with PVTT. The control group also had two subgroups: Group C (n = 37) without PVTT and group D (n = 17) with PVTT. Data on patient demographics, disease characteristics, therapy response, and adverse events (AEs) were collected. The overall survival (OS) and recurrence-free survival (RFS) rates were assessed using Kaplan-Meier curves. Univariate and multivariate Cox regression analyses were conducted to determine the parameters that were independently related to OS and RFS.

RESULTS

The DEB-TACE group exhibited an overall response rate of 86.6%. Following therapy, there was a significant decrease in the median alpha-fetoprotein (AFP) level (275.1 ng/mL vs 41.7 ng/mL, P < 0.001). The main AE was post-embolization syndrome. The 2-year rates of RFS and OS were significantly higher in the DEB-TACE group than in the control group (68.9% vs 38.9%, P = 0.003; 86.7% vs 63.0%, P = 0.008). Within the subgroups, group A had higher 2-year rates of RFS and OS compared to group C (71.0% vs 45.9%, P = 0.038; 83.8% vs 62.2%, P = 0.047). The 2-year RFS rate of group B was markedly superior to that of group D (64.3% vs 23.5%, P = 0.002). Results from multivariate analyses showed that pre-LT DEB-TACE [hazard ratio (HR) = 2.73, 95% confidence interval (CI): 1.44-5.14, P = 0.04], overall target tumor diameter ≤ 7 cm (HR = 1.98, 95%CI: 1.05-3.75, P = 0.035), and AFP level ≤ 400 ng/mL (HR = 2.34; 95%CI: 1.30-4.19, P = 0.009) were significant risk factors for RFS. Additionally, pre-LT DEB-TACE (HR = 3.15, 95%CI: 1.43-6.96, P = 0.004) was identified as a significant risk factor for OS.

CONCLUSION

DEB-TACE is a safe and efficient therapy for advanced-stage HCC and also enhances patient survival after LT.

Keywords: Hepatocellular carcinoma, Liver transplantation, Portal vein tumor thrombus, Drug-eluting bead transarterial chemoembolization, Neoadjuvant treatment

Core Tip: This retrospective study investigated the value of drug-eluting bead transarterial chemoembolization (DEB-TACE) as neoadjuvant therapy pre-liver transplantation (LT) for advanced-stage hepatocellular carcinoma. We identified 99 relevant cases among our patient population and followed their overall survival (OS) and recurrence-free survival. The results indicated that DEB-TACE before LT may prolong OS and reduce recurrence rate.