Safety and efficacy assessment of transarterial chemoembolization using drug-eluting beads in patients with hepatocellular carcinoma and arterioportal shunt: a single-center experience

Figures & data

Table 1 Clinical findings of two groups

Characteristic	DEB-TACE group	PVA-TACE group	P-value
Age (years)	52.8±9.9	54.3±12.0	0.617
Sex (male/female, %)	22/4, 84.6/15.4	27/5, 84.4/15.6	1.000
Tumor size (mm)	97.2±38.2	108.1±59.0	0.421
Albumin (g/L)	34.2±3.5	35.8±3.9	0.114
Bilirubin (umol/L)	17.8±7.7	17.3±9.2	0.854
Child–Pugh class (A/B, %)	20/6, 76.9/23.1	21/11, 65.6/34.4	0.347
PVTT (yes/no, %)	12/14, 46.1/53.9	13/19, 40.6/59.4	0.672
Ascites (yes/no, %)	5/21, 19.2/80.8	10/22, 31.2/68.8	0.299
APS grading (1/2/3, %)	12/10/4, 46.1/38.5/15.4	11/15/6, 34.4/46.9/18.7	0.730
BCLC staging (B/C, %)	13/13, 50.0/50.0	15/17, 46.9/53.1	0.813
ECOG ps (0/1/2, %)	7/17/2, 26.9/65.4/7.7	10/16/6, 31.2/50.0/18.8	0.400
Distant metastasis (yes/no, %)	2/24, 7.7/92.3	6/26, 18.7/81.3	0.205

Abbreviations: APS, arterioportal shunt; BCLC, Barcelona Clinic Liver Cancer; DEB-TACE, transarterial chemoembolization with drug-eluting beads; ECOG ps, Eastern Cooperative Oncology Group performance status; PVA-TACE, polyvinyl alcohol plus transarterial chemoembolization; PVTT, portal vein tumor thrombus.

Figure 1 Tumor response of patients in the group with transarterial chemoembolization with drug-eluting beads.

Notes: A 48-year-old male with hepatocellular carcinoma and grade 3 arterioportal shunt: contrast-enhanced computed tomography scan showed a hepatic arterial phase hyperattenuation lesion with a maximal diameter of 106.5 mm, the arterial flow was drained into the main portal vein (black arrow) (A), and the portal venous phase showed tumor thrombus (white arrow) (B); a follow-up magnetic resonance scan was performed after 3 months, showing that the maximal diameter of the tumor was increased to 151.8 mm and indicating a tumor response of progression disease, the hepatic arterial phase (C), and the portal venous phase (D).

Table 2 Efficacy assessment of two groups

Efficacy assessment	DEB-TACE group	PVA-TACE group	P
Shunt recurrence (yes/no, %)	3/23, 11.5/88.5	2/30, 6.3/93.7	0.648
Objective response (CR + PR/SD + PD, %)	8/18, 30.8/69.2	4/28, 12.5/87.5	0.088
Disease control (CR + PR+SD/PD, %)	18/8, 69.2/30.8	12/20, 37.5/62.5	0.016

Abbreviations: CR, complete response; DEB-TACE, transarterial chemoembolization with drug-eluting beads; PD, progression disease; PR, partial response; PVA-TACE, polyvinyl alcohol plus transarterial chemoembolization; SD, stable disease.

Figure 2 The overall survival of patients in the DEB-TACE group and PVA-TACE group.

Abbreviations: DEB-TACE, transarterial chemoembolization with drug-eluting beads; PVA-TACE, polyvinyl alcohol plus transarterial chemoembolization.

Table 3 Univariate and multivariate analyses of survival in DEB-TACE group

Variables	Categories	Univariates			Multivariates
		Median OS (days)	χ^2	P	HR (95% CI)	P-value
Sex	Male	346	0.018	0.893
	Female	322
Child–Pugh Class	A	370	1.536	0.215
	B	244
Tumor response	PR	534	11.252	0.004	2.051 (1.039–4.047)	0.038
	SD	346
	PD	240
APS grade	1	425	11.442	0.003	3.101 (1.268–7.587)	0.013
	2	346
	3	184
Ascites	Absence	370	0.805	0.369
	Presence	346
PVTT	Absence	370	1.916	0.166
	Presence	333
ALB	>35	322	2.851	0.240
	28–35	346
	<28	371
Total bilirubin	<34	370	11.266	0.001	103.139 (4.658–2283.906)	0.003
	34–51	106
ECOG ps	0	389	1.530	0.465
	1	322
	2	346
Tumor size	<50 mm	534	6.227	0.013
	≥50 mm	322

Abbreviations: ALB, albumin; APS, arterioportal shunt; DEB-TACE, transarterial chemoembolization with drug-eluting beads; ECOG ps, Eastern Cooperative Oncology Group performance status; OS, overall survival; PD, progression disease; PR, partial response; PVTT, portal venous tumor thrombus; SD, stable disease.

Table 4 Safety assessment of two groups

Safety assessment	DEB-TACE group	PVA-TACE group	P-value
Clinical toxicity (grade 1–2)
Fever (yes/no, %)	16/10, 61.5/38.5	27/5, 84.4/15.6	0.048
Abdominal pain (yes/no, %)	22/4, 84.6/15.4	28/4, 87.5/12.5	1.000
Vomiting (yes/no, %)	3/23, 11.5/88.5	5/27, 15.6/84.4	1.000
Clinical toxicity (grade 3–4)
GI bleeding (yes/no, %)	1/25, 3.8/96.2	0/32, 0/100	0.448
Unbearable pain or fever (yes/no, %)	5/21, 19.2/80.8	8/24, 25.0/75.0	0.600
Hepatic failure (yes/no, %)	0/26, 0/100	0/32, 0/100	NA
Laboratory toxicity (grade 1–2)
Increased transaminases (yes/no, %)	12/14, 46.2/53.8	23/9, 71.9/28.1	0.046
Increased bilirubin (yes/no, %)	6/20, 23.1/76.9	7/25, 26.9/78.1	0.913
Increased alkaline phosphatase (yes/no, %)	3/23, 11.5/88.5	3/29, 9.4/90.6	1.000
Laboratory toxicity (grade 3–4)
Increased transaminases (yes/no, %)	5/21, 19.2/80.8	7/25, 21.9/78.1	0.805
Increased bilirubin (yes/no, %)	0/26, 0/100	1/31, 3.1/96.9	1.000
Increased alkaline phosphatase (yes/no, %)	0/26, 0/100	0/32, 0/100	NA

Abbreviations: DEB-TACE, transarterial chemoembolization with drug-eluting beads; GI, gastrointestinal; PVA-TACE, polyvinyl alcohol plus transarterial chemoembolization.