Drug-Eluting Beads versus Lipiodol Transarterial Chemoembolization for the Treatment of Hypovascular Hepatocellular Carcinoma: A Single-Center Retrospective Study

Figures & data

Figure 1 An illustrative case of 61-year-old man who went DEB-TACE treatment. (A) Contrast-enhanced CT showed a tumor with weak enhancement near the hepatic hilar region. (B) DSA showed that faint tumor staining before treatment. (C) After DEB-TACE treatment, the tumor staining and obvious tumor nodule disappeared on DSA. (D) One month after treatment, enhanced CT revealed that tumor density decreased and necrosis occurred. (E) Three months after treatment, tumor shrunk and no recurrence or intrahepatic metastasis occurred.

Abbreviations: DEB-TACE, drug-eluting beads transarterial chemoembolization; CT, computed tomography; DSA, digital subtraction angiography.

Table 1 Baseline Data of Patients in the Study

Variables	DEB-TACE Group (n=46)	C-TACE Group (n=52)	P value
Age (years)*	59.59 ± 9.74	58.10 ± 12.37	0.513
Sex			0.814
Male	38 (82.6%)	42 (80.8%)
Female	8 (17.4%)	10 (19.2%)
Etiology			0.383
Hepatitis B or C virus	33 (71.7%)	33 (63.5%)
Other etiology	13 (28.3%)	19 (36.5%)
Previous treatment			0.152
Untreated	19 (41.3%)	16 (30.8%)
Surgery	8 (17.4%)	20 (38.5%)
C-TACE	12 (26.1%)	13 (25.0%)
Ablation	2 (4.3%)	1 (1.9%)
Systemic treatment	5 (10.9%)	2 (3.8%)
Tumor size (cm)			0.614
≤5	26 (56.5%)	32 (61.5%)
>5	20 (43.5%)	20 (38.5%)
Number of nodules			0.856
Single	16 (34.8%)	19 (36.5%)
Multiple	30 (65.2%)	33 (63.5%)
Type of selectivity			0.979
Lobar	5 (10.9%)	6 (11.5%)
Segmental	26 (56.5%)	30 (57.7%)
Subsegmental	15 (32.6%)	16 (30.8%)
Child-Pugh class			0.601
A	39 (84.8%)	42 (80.8%)
B	7 (15.2%)	10 (19.2%)
BCLC stage			0.845
A	15 (32.6%)	16 (30.8%)
B	31 (67.4%)	36 (69.2%)
α-Fetoprotein (μg/L)			0.845
≤400	31 (67.4%)	36 (69.2%)
>400	15 (32.6%)	16 (30.8%)
Follow-up period (months)*	14.32 ± 8.98	14.20 ± 9.22	0.951

Note: Data are numbers of patients unless indicated. Data in parentheses are percentages. *Data are expressed as the means ± standard deviation.

Abbreviations: DEB-TACE, drug-eluting beads transarterial chemoembolization; C-TACE, conventional transarterial chemoembolization; BCLC, Barcelona clinic liver cancer.

Table 2 Assessment of Tumor Response Between Two Treatment Groups

Response	DEB-TACE Group (n=46)	C-TACE Group (n=52)	P value
CR	7 (15.2%)	2 (3.9%)	0.111
PR	28 (60.9%)	19 (36.5%)	0.016
SD	7 (15.2%)	18 (34.6%)	0.028
PD	4 (8.7%)	13 (25.0%)	0.033
ORR	35 (76.1%)	21 (40.4%)	<0.001
DCR	42 (91.3%)	39 (75.0%)	0.033

Abbreviations: DEB-TACE, drug-eluting beads transarterial chemoembolization; C-TACE, conventional transarterial chemoembolization; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease; ORR, objective response rate; DCR, disease control rate.

Table 3 The Comparison of Adverse Events Between Two Treatment Groups

AEs	DEB-TACE Group (n=46)	C-TACE Group (n=52)	P value
Acute liver function impairment	3 (6.5%)	3 (5.8%)	0.877
Acute renal insufficiency	1 (2.2%)	0	0.469
Hypoalbuminemia	5 (10.9%)	5 (9.6%)	0.838
Anemia	1 (2.2%)	5 (10.9%)	0.210
Vomiting	15 (32.6%)	11 (21.2%)	0.200
Fever	5 (10.9%)	10 (19.2%)	0.251
Abdominal pain	20 (43.5%)	18 (34.6%)	0.369
Diarrhea	1 (2.2%)	0	0.469
Total	31 (67.4%)	30 (57.7%)	0.323

Abbreviations: AEs, adverse events; DEB-TACE, drug-eluting beads transarterial chemoembolization; C-TACE, conventional transarterial chemoembolization.

Figure 2 Kaplan-Meier curves of PFS for DEB-TACE and C-TACE groups.

Figure 3 Kaplan-Meier curves of OS for DEB-TACE and C-TACE groups.

Table 4 Univariate and Multivariate Analysis of Prognostic Factors Affecting PFS and OS

Parameters	Univariate Analysis			Multivariate Analysis
	HR	95% CI	P value	HR	95% CI	P value
PFS
DEB-TACE	0.387	0.229–0.652	<0.001	0.384	0.228–0.647	<0.001
Male	1.195	0.657–2.172	0.559	—	—	—
Previous treatment	1.128	0.676–1.881	0.646	—	—	—
Hepatitis B or C virus	1.018	0.614–1.688	0.945	—	—	—
Tumor size >5 cm	1.637	0.996–2.691	0.052	1.665	1.013–2.737	0.044
Child-Pugh B class	0.918	0.451–1.868	0.813	—	—	—
BCLC B stage	1.100	0.661–1.831	0.713	—	—	—
AFP >400 μg/L	1.053	0.626–1.770	0.846	—	—	—
Repeated TACE	0.698	0.372–1.309	0.263	—	—	—
AEs	1.005	0.617–1.638	0.983	—	—	—
OS
DEB-TACE	0.505	0.263–0.973	0.041	0.246	0.106–0.568	<0.001
Male	1.080	0.516–2.260	0.838	—	—	—
Previous treatment	0.801	0.429–1.496	0.486	—	—	—
Hepatitis B or C virus	0.709	0.379–1.328	0.283	—	—	—
Tumor size >5 cm	1.317	0.713–2.433	0.379	—	—	—
Child-Pugh B class	1.615	0.710–3.672	0.253	—	—	—
BCLC B stage	1.320	0.663–2.630	0.430	—	—	—
AFP >400 μg/L	0.590	0.289–1.202	0.146	—	—	—
Repeated TACE	0.270	0.132–0.555	<0.001	0.113	0.044–0.291	<0.001
AEs	0.994	0.539–1.834	0.985	—	—	—

Abbreviations: HR, hazard ratio; CI, confidence interval; PFS, progression-free survival; DEB-TACE, drug-eluting beads transarterial chemoembolization; BCLC, Barcelona clinic liver cancer; AFP, α-fetoprotein; TACE, transarterial chemoembolization; AEs, adverse events; OS, overall survival.