Transarterial embolization is an acceptable bridging therapy to hepatocellular carcinoma prior to liver transplantation

Table 1 Patient, tumor, and treatment characteristics, n (%)

Variables	TACE	TAE	P value
Number	65	38
Age (yr), median (IQR)	60 (55, 65)	61.5 (55, 64)	0.962
Male sex	40 (61.5)	23 (60.5)	> 0.99
Diagnosis			0.889
HCV	51 (78.5)	32 (84.2)
HBV	4 (6.2)	2 (5.3)
Alcohol	4 (6.2)	3 (7.9)
NASH	4 (6.2)	1 (2.6)
Other	2 (3.1)	0
Calculated MELD score, median (IQR)	9 (8, 12)	11 (9, 12)	0.122
Preprocedural AFP level, median (IQR)	22.5 (5.6, 68.3)	15.75 (6.8, 94.5)	0.992
Number of lesions			0.652
1	37 (56.9)	22 (57.9)
2	18 (27.7)	11 (28.9)
3	10 (15.4)	4 (10.5)
≥ 4	0	1 (2.6)
Largest tumor diameter, median (IQR)	3 (2.4, 3.8)	3.3 (2.4, 3.9)	0.634
Milan-out	10 (15.4)	8 (21.1)	0.591
Use of PEI	25 (38.5)	17 (44.7)	0.541
Number of procedures, median (IQR)	2 (1, 3)	2 (1, 2.75)	0.914

Milan-out refers to patients beyond the limits of the Milan criteria. TACE: Transarterial chemoembolization; TAE: Transarterial embolization; HCV: Hepatitis-C virus; HBV: Hepatitis-B virus; MELD: Model for End-Stage Liver Disease; AFP: Alpha-feto protein; PEI: Percutaneous ethanol injection; IQR: Interquartile range; NASH: Non-alcoholic steatohepatitis.

Table 2 Dropout due to tumor progression in the treatment groups, n (%)

	Dropout due to tumor progression
		No	Yes
TACE	TACE only	33 (82.5)	7 (17.5)
	TACE + PEI	20 (80)	5 (20)
	Overall TACE	53 (81.5)	12 (18.5)
TAE	TAE only	19 (90.5)	2 (9.5)
	TAE + PEI	16 (94.1)	1 (5.9)
	Overall TAE	35 (92.1)	3 (7.9)

Fisher’s exact test for comparison of the four groups [transarterial chemoembolization (TACE) only, TACE + percutaneous ethanol injection (PEI), transarterial embolization (TAE) only, and TAE + PEI]: P = 0.565. Fisher’s exact test for comparison of the two groups (Overall TACE vs overall TAE): P = 0.162. TACE: Transarterial chemoembolization; TAE: Transarterial embolization; PEI: Percutaneous ethanol injection.

Table 3 Patient, tumor, and treatment characteristics of patients who underwent liver transplantation, n (%)

Variables	TACE	TAE	P value
Number	48	29
Age (yr), median (IQR)	60.5 (55.75, 65.25)	62 (53, 63)	0.458
Male sex	30 (62.5)	19 (65.5)	0.812
Diagnosis			0.385
HCV	37 (77.1)	25 (86.2)
HBV	4 (8.3)	1 (3.4)
Alcohol	3 (6.2)	3 (10.3)
NASH	4 (8.3)	0
Other	0	0
Calculated MELD score, median (IQR)	9 (8, 11.25)	11 (9, 12)	0.109
Pretransplant AFP, median (IQR)	11.7 (4.77, 46)	9.1 (4.4, 31.95)	0.668
Number of lesions			0.704
1	29 (60.4)	16 (55.2)
2	12 (25)	8 (27.6)
3	7 (14.6)	4 (13.8)
≥ 4	0	1 (3.4)
Largest tumor diameter, median (IQR)	2.8 (2.3, 3.8)	3.3 (2.5, 3.6)	0.333
Milan-out	5 (10.4)	8 (27.6)	0.064
Use of PEI	19 (39.6)	15 (51.7)	0.348
Complete pathological response	7 (14.6)	9 (31)	0.145
Vascular invasion	8 (16.7)	4 (13.8)	> 0.99

Milan-out refers to patients beyond the limits of the Milan criteria. TACE: Transarterial chemoembolization; TAE: Transarterial embolization; HCV: Hepatitis-C virus; HBV: Hepatitis-B virus; MELD: Model for End-Stage Liver Disease; PEI: Percutaneous ethanol injection; IQR: Interquartile range; NASH: Non-alcoholic steatohepatitis.