Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarte...Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarterial chemoembolization(TACE)as an adjuvant therapy in HCC patients with high risk of recurrence.Methods:Patients were enrolled from eight hepatobiliary centers in China.The primary endpoint was disease-free survival(DFS).The secondary endpoints were overall survival(OS)and safety.Additionally,propensity score matching(PSM)and other three propensity score analyses were performed to balance the potential baseline bias to validate the conclusion.The adverse events(AEs)were recorded throughout the study.The study was registered at Clinical Trials.gov(NCT03838796).Results:A total of 297 patients were enrolled,with 147 in the LEN+TACE group and 150 in the TACE group.Before PSM,the LEN+TACE group achieved significantly better DFS than the TACE group(19.0 vs.10.0 months,P=0.011).PSM analysis identified 111 matched pairs.After PSM,the LEN+TACE group also showed better DFS(19.0 vs.9.0 months,P=0.018).Other three propensity score analyses yielded similar DFS benefit tendency.Furthermore,favorable OS was also obtained in the LEN+TACE group before PSM.Lenvatinib related AEs of grade 3 or 4 occurred in 28.6%of the patients in the LEN+TACE group.Conclusions:Adjuvant lenvatinib plus TACE might be a promising adjuvant approach for HCC patients with high risk of recurrence,which could significantly prolong DFS and potentially OS with a manageable safety profile.展开更多
Hepatocellular carcinoma(HCC)remains one of the most common cancers worldwide.Transcatheter arterial chemoembolization has become a common treatment modality for some patients with unresectable advanced HCC.Since the ...Hepatocellular carcinoma(HCC)remains one of the most common cancers worldwide.Transcatheter arterial chemoembolization has become a common treatment modality for some patients with unresectable advanced HCC.Since the introduction of nanomaterials in 1974,their use in various fields has evolved rapidly.In medical applications,nanomaterials can serve as carriers for the delivery of chemotherapeutic drugs to tumour tissues.Additionally,nanomaterials have potential for in vivo tumour imaging.This article covers the properties and uses of several kinds of nanomaterials,focusing on their use in transcatheter arterial chemoembolization for HCC treatment.This paper also discusses the limitations currently associated with the use of nanomaterials.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a common tumor with a poor prognosis.Early intervention is essential;thus,good prognostic markers to identify patients who benefit from first transarterial chemoembolization(...BACKGROUND Hepatocellular carcinoma(HCC)is a common tumor with a poor prognosis.Early intervention is essential;thus,good prognostic markers to identify patients who benefit from first transarterial chemoembolization(TACE)are needed.AIM To investigate the efficacy of computed tomography(CT)radiomics in predicting the success of the first TACE in patients with advanced HCC and to develop an early prediction model based on clinical radiomics features.METHODS Data from 122 patients with advanced HCC treated with TACE were analyzed.Intratumoral and peritumoral areas on arterial and venous CT images were selected to extract radiomic features,which were screened in the training cohort using the minimum redundancy maximum correlation.Then,support vector machines were used to construct the model.To construct a receiver operating characteristic curve,the predictive efficacy of each model was evaluated on the basis of the area under the curve(AUC).RESULTS Among the 122 patients,72 patients were effectively treated via TACE,and in 50 patients,this treatment was ineffective.In the radiomics model,the areas under the curve of the venous phase model were 0.867(95%CI:0.790-0.940)in the training cohort and 0.755(0.600-0.910)in the validation cohort,indicating good predictive efficacy.The multivariate logistic regression results indicated that preoperative alpha-fetoprotein levels(P=0.01)were a risk factor for TACE.The screened clinical features were combined with the radiomic features to construct a combined model.This combined model had an AUC of 0.92(0.87-0.95)in the training cohort and 0.815(0.67-0.95)in the validation cohort.CONCLUSION CT radiomics has good value in predicting the efficacy of the first TACE treatment in patients with HCC.The combined model was a better tool for predicting the first TACE efficacy in patients with advanced HCC and could provide an efficient predictive tool to help with the selection of patients for TACE.展开更多
BACKGROUND Transcatheter arterial chemoembolization(TACE)is a key treatment approach for advanced invasive liver cancer(infiltrative hepatocellular carcinoma).However,its therapeutic response can be difficult to evalu...BACKGROUND Transcatheter arterial chemoembolization(TACE)is a key treatment approach for advanced invasive liver cancer(infiltrative hepatocellular carcinoma).However,its therapeutic response can be difficult to evaluate accurately using conventional two-dimensional imaging criteria due to the tumor’s diffuse and multifocal growth pattern.Volumetric imaging,especially enhanced tumor volume(ETV),offers a more comprehensive assessment.Nonetheless,bias field inhomogeneity in magnetic resonance imaging(MRI)poses challenges,potentially skewing volumetric measurements and undermining prognostic evaluation.AIM To investigate whether MRI bias field correction enhances the accuracy of volumetric assessment of infiltrative hepatocellular carcinoma treated with TACE,and to analyze how this improved measurement impacts prognostic prediction.METHODS We retrospectively collected data from 105 patients with invasive liver cancer who underwent TACE treatment at the Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2024.The improved N4 bias field correction algorithm was applied to process MRI images,and the ETV before and after treatment was calculated.The ETV measurements before and after correction were compared,and their relationship with patient prognosis was analyzed.A Cox proportional hazards model was used to evaluate prognostic factors,with Martingale residual analysis determining the optimal cutoff value,followed by survival analysis.RESULTS Bias field correction significantly affected ETV measurements,with the corrected baseline ETV mean(505.235 cm^(3))being significantly lower than before correction(825.632 cm^(3),P<0.001).Cox analysis showed that the hazard ratio(HR)for corrected baseline ETV(HR=1.165,95%CI:1.069-1.268)was higher than before correction(HR=1.063,95%CI:1.031-1.095).Using 412 cm^(3) as the cutoff,the group with baseline ETV<415 cm^(3) had a longer median survival time compared to the≥415 cm^(3) group(18.523 months vs 8.926 months,P<0.001).The group with an ETV reduction rate≥41%had better prognosis than the<41%group(17.862 months vs 9.235 months,P=0.006).Multivariate analysis confirmed that ETV reduction rate(HR=0.412,P<0.001),Child-Pugh classification(HR=0.298,P<0.001),and Barcelona Clinic Liver Cancer stage(HR=0.578,P=0.045)were independent prognostic factors.CONCLUSION Volume imaging based on MRI bias field correction can improve the accuracy of evaluating the efficacy of TACE treatment for invasive liver cancer.The corrected ETV and its reduction rate can serve as independent indicators for predicting patient prognosis,providing important reference for developing individualized treatment strategies.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is the most common form of liver cancer that has limited treatment options and a poor prognosis.Transarterial chemoembolization(TACE)is the first-line treatment for intermediate...BACKGROUND Hepatocellular carcinoma(HCC)is the most common form of liver cancer that has limited treatment options and a poor prognosis.Transarterial chemoembolization(TACE)is the first-line treatment for intermediate-stage HCC but can induce tumour hypoxia,thereby promoting angiogenesis.Recent studies suggested that combining TACE with anti-angiogenic therapies and immunotherapy might im-prove efficacy.Lenvatinib,a tyrosine kinase inhibitor,has demonstrated superior outcomes compared to sorafenib,while immune checkpoint inhibitors such as sintilimab show potential when combined with TACE.However,the efficacy and safety of TACE combined with lenvatinib and sintilimab(TACE+SL)compared to TACE with lenvatinib alone(TACE+L)in patients with intermediate-ad-vanced HCC has not yet been investigated.AIM To evaluate the efficacy and safety of TACE+SL therapy in comparison to TACE+L therapy in patients with intermediate-advanced HCC.METHODS A retrospective analysis was performed on patients with intermediate-advanced HCC who received TACE plus lenvatinib with or without sintilimab between September 2019 and September 2022.Baseline characteristics were compared,and propensity score matching was applied.Overall survival(OS),progression-free survival(PFS),and objective response rate(ORR)were evaluated between the two groups,and adverse events were analyzed.RESULTS The study included 57 patients,with 30 in the TACE+SL group and 27 in the TACE+L group.The TACE+SL group demonstrated significantly improved median PFS and OS compared to the TACE+L group(PFS:14.1 months vs 9.6 months,P=0.016;OS:22.4 months vs 14.1 months,P=0.039),along with a higher ORR(70.0%vs 55.6%).After propensity score matching,30 patients were included,with the TACE+SL group again showing longer median PFS and a trend toward improved OS(PFS:14.6 months vs 9.2 months,P=0.012;OS:23.9 months vs 16.3 months,P=0.063),and a higher ORR(73.3%vs 53.3%).No severe adverse events were reported.CONCLUSION TACE+SL demonstrated superior outcomes in terms of OS and PFS,compared to TACE+L.These findings suggest that the addition of sintilimab might enhance the therapeutic response in patients with intermediate-advanced HCC.展开更多
BACKGROUND Transarterial chemoembolization(TACE)is a widely accepted palliative therapy modality for unresectable hepatocellular carcinoma(HCC).Although it is rarely curative,complete radiological response can be achi...BACKGROUND Transarterial chemoembolization(TACE)is a widely accepted palliative therapy modality for unresectable hepatocellular carcinoma(HCC).Although it is rarely curative,complete radiological response can be achieved in selected patients,leading to prolonged survival.Post-treatment tumoral calcification is an uncom-mon imaging finding in HCC and is rarely reported after drug-eluting beads TACE(DEB-TACE).CASE SUMMARY Two patients with large,solitary HCCs(>5 cm)were treated with DEB-TACE,and both achieved complete radiological response after two treatment sessions.Approximately 1 year after DEB-TACE,imaging demonstrated progressive peripheral tumoral calcification.Over 6 years of follow-up,both patients remained in remission with preserved liver function.CONCLUSION These two cases highlight the potential for complete remission and long-term survival in selected patients with large HCC following DEB-TACE.The appearance of peripheral calcification may represent a late imaging marker of effective tumor necrosis and durable treatment response although prospective studies are warranted to clarify its prognostic value.展开更多
BACKGROUND Intrahepatic cholangiocarcinoma(iCCA)is the second most common liver malignancy with poor prognosis and limited treatment options.AIM To identify the most effective drug for transarterial chemoembolization(...BACKGROUND Intrahepatic cholangiocarcinoma(iCCA)is the second most common liver malignancy with poor prognosis and limited treatment options.AIM To identify the most effective drug for transarterial chemoembolization(TACE)in cholangiocarcinoma and evaluate the efficacy and safety of combining it with gemcitabine and cisplatin(GemCis)for unresectable iCCA.METHODS Cholangiocarcinoma cell lines(RBE,HuCC-T1)were treated with 10 chemotherapeutic drugs,and cytotoxicity was assessed by cell counting kit-8 assays.Tumorbearing nude mice were treated with idarubicin or GemCis,and tumor growth was monitored.Clinical data from 85 iCCA patients were analyzed to evaluate the efficacy and safety of idarubicin-TACE combined with GemCis.RESULTS Idarubicin demonstrated the highest cytotoxicity,significantly outperforming GemCis,the standard first-line therapies.In tumor-bearing mouse models,idarubicin and GemCis treatments significantly slowed tumor growth,with idarubicin showing particularly pronounced effects on days 12 and 15(P<0.05).In retrospective analysis,the median overall survival(OS)and progression-free survival(PFS)in the combination therapy group were significantly longer than those in the GemCis alone group(median OS,16.23 months vs 10.07 months,P=0.042;median PFS,7.73 months vs 6.30 months,P=0.023).Additionally,major grade 3/4 adverse events(AEs)in the combination therapy group were abdominal pain(26.3%vs 6.5%,P=0.049)and elevated transaminases(42.1%vs 12.9%,P=0.038).Most AEs were mild to moderate and manageable.CONCLUSION Idarubicin demonstrated higher cytotoxicity than GemCis,significantly inhibiting tumor growth in tumor-bearing mouse models.Preliminary clinical results suggest that local idarubicin-TACE combined with GemCis may offer improved survival outcomes for iCCA patients with a manageable safety profile.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide and currently lacks effective treatment options.This is particularly true for advanced HCC,for which conventional therapies...BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide and currently lacks effective treatment options.This is particularly true for advanced HCC,for which conventional therapies often lead to a poor prognosis.AIM To assess the safety and efficacy of transarterial chemoembolization(TACE)with donafenib and immune checkpoint inhibitors(ICIs)for unresectable HCC.METHODS We retrospectively assessed the data of patients with HCC who underwent TACE combined with donafenib and an ICI(tislelizumab or cedilimumab).Patients received oral donafenib daily for 2 weeks before TACE,followed by tislelizumab or cedilimumab 200 mg intravenously on day 1 of a 21-day therapeutic cycle.The primary endpoints were objective response rate,disease control rate,and duration of response according to the modified RECIST criteria.The secondary endpoint was presence of treatment-related adverse events(TRAEs).RESULTS The median follow-up was 7.8 months(95%CI:5.0-11.8 months).The objective response rate was 60.0%(18/30),while the disease control rate was 93.3%.The median duration of response in confirmed responders was 6.6 months(95%CI:1.3-12.9 months).The median progression-free survival was 11.8 months(95%CI:8.3-15.4 months).More than half of the patients survived until the end of the study.Grade>3 TRAEs occurred in 40%of the patients with no grade 5 TRAEs reported.The most common grade 3/4 TRAE was palmar-plantar erythrodysesthesia,a dermatologic condition characterized by painful redness and swelling of the palms and soles,with an incidence of 56.7%.No ICI-related adverse effects were observed.CONCLUSION TACE combined with donafenib and ICI is a promising and safe therapeutic regimen for unresectable HCC.展开更多
BACKGROUND Lenvatinib and sorafenib are tyrosine kinase inhibitors that are effective in the treatment of unresectable hepatocellular carcinoma(uHCC).The efficacy of which of them is better suited to combine transarte...BACKGROUND Lenvatinib and sorafenib are tyrosine kinase inhibitors that are effective in the treatment of unresectable hepatocellular carcinoma(uHCC).The efficacy of which of them is better suited to combine transarterial chemoembolization(TACE)for the treatment of uHCC is ripe.RESULTS A total of six studies involving 547 patients were included,248 in the TACE-lenvatinib group and 299 in the TACE-sorafenib group.Meta-analysis results showed that TACE-lenvatinib was more effective than TACE-sorafenib in complete response[relative risk(RR)=1.81,95%confidence interval(CI):1.11-2.96,P=0.02],partial response(RR=1.38,95%CI:1.12-1.70,P=0.002),objective response rate(RR=1.47,95%CI:1.24-1.74,P<0.0001)and disease control rate(RR=1.22,95%CI:1.00-1.49,P=0.05).TACE-lenvatinib was significantly lower than TACE-sorafenib in progressive disease rate(RR=0.54,95%CI:0.39-0.74,P=0.002).No significant difference was found in stable disease rate(RR=0.89,95%CI:0.60-1.33,P=0.58)between the two groups.TACE-lenvatinib was significantly more effective than TACE-sorafenib in overall survival(hazard ratio=2.00,95%CI:1.59-2.50,P<0.05)and progression free survival(hazard ratio=2.04,95%CI:1.49-2.86,P<0.05).As regards adverse events,TACE-lenvatinib was better in reducing the incidence of hypertension than TACE-sorafenib,while no significant difference was found in overall adverse events,abdominal pain,fever,fatigue,nausea and vomiting,decreased appetite,liver dysfunction,hand-foot skin reaction,diarrhea,thrombocytopenia,and rash between the two groups.CONCLUSION In patients with uHCC,TACE-lenvatinib induced a better tumor response rate and survival outcome than TACE-sorafenib,while TACE-lenvatinib resulted in a higher incidence of hypertension than TACE-sorafenib.However,these conclusions are derived from currently available medical evidence,and further confirmation by more rigorously designed randomized controlled studies is still needed.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a major health concern in Thailand,with most patients diagnosed at the intermediate stage.Transarterial chemoembolization(TACE)is the standard treatment;however,postembolizat...BACKGROUND Hepatocellular carcinoma(HCC)is a major health concern in Thailand,with most patients diagnosed at the intermediate stage.Transarterial chemoembolization(TACE)is the standard treatment;however,postembolization syndrome(PES)remains a common complication.Although both dexamethasone(DEXA)and N-acetylcysteine(NAC)have shown efficacy in reducing PES,no study has directly compared their effects.AIM To compare the incidence of PES between DEXA and NAC in intermediate-stage HCC patients undergoing conventional TACE(cTACE).METHODS A randomized,double-blind,controlled trial was conducted at two tertiary hospitals in Thailand from November 2024 to April 2025.Eligible HCC patients(aged 18-70 years)were randomized(1:1)to receive either NAC(150 mg/kg/hour loading dose,followed by 50 mg/kg over 4 hours,then 6.25 mg/kg/hour for 48 hours post-cTACE)or DEXA(8 mg IV 1 hour before cTACE).cTACE was performed by blinded interventional radiologists.The primary outcome was PES occurrence within 48 hours,assessed using South West Oncology Group toxicity coding and the Common Terminology Criteria for Adverse Events.The secondary outcomes were post-cTACE liver decompensation and the dynamic changes in the albumin-bilirubin(ALBI)score.RESULTS A total of 56 intermediate-stage HCC patients were included(DEXA,n=28;NAC,n=28).Most had preserved liver function,with 92.9%classified as Child-Pugh A.The maximum tumor size was 6.2 cm,and 85.7%had multiple lesions.Additionally,39 patients(69.6%)met the beyond up-to-7 criteria.Overall,27 patients(48.2%)developed PES.After adjusting for confounding factors,the NAC group had a significantly lower incidence of PES than the DEXA group(32.1%vs 64.3%;adjusted odds ratio=0.17,95%confidence interval:0.03-0.87,P=0.033).Only two patients(3.6%)developed post-cTACE liver decompensation.Furthermore,51.8%patients experienced worsening ALBI scores within 48 hours post-procedure;however,the rate of ALBI score worsening did not significantly differ between the groups.CONCLUSION Compared with DEXA,NAC significantly reduces the incidence of PES,regardless of its impact on liver function recovery.Therefore,NAC is a preferable option for reducing PES in Barcelona Clinic Liver Cancer-B stage HCC patients with preserved liver function.展开更多
BACKGROUND Although the triple therapy of transarterial chemoembolization(TACE)combined with immune checkpoint inhibitors and tyrosine kinase inhibitors is becoming an effective treatment for unresectable hepatocellul...BACKGROUND Although the triple therapy of transarterial chemoembolization(TACE)combined with immune checkpoint inhibitors and tyrosine kinase inhibitors is becoming an effective treatment for unresectable hepatocellular carcinoma(uHCC).However,there is still a lack of effective tools for predicting therapeutic effects at present.AIM To develop a predictive tool for the prognosis of uHCC patients treated with TACE,sintilimab and lenvatinib.METHODS Based on multicenter data,this study constructed and validated an AADN score as variables to predict overall survival in patients treated with this combination therapy.This study included 188 uHCC cases(training cohort:n=101,validation cohort:n=87)from three different hospitals.Who were treated with TACE,sintilimab and lenvatinib.RESULTS In multivariate analysis,alpha-fetoprotein≥100 ng/mL[hazard ratio(HR)=2.579,P=0.010],alkaline phosphatase>120 U/L,(HR=2.234,P=0.021),direct bilirubin>7.3μmol/L(HR=2.931,P=0.007)and neutrophil to lymphocyte ratio>2.5(HR=3.127,P=0.006)were identified as independent prognostic factors and were used to establish the AADN score.Kaplan-Meier survival curves and time-dependent receiver operating characteristic curves were used to assess the accuracy of the AADN score,with area under receiver operating characteristic curve values of 0.827(training cohort,95%confidence interval:0.743-0.911)and 0.832(validation cohort,95%confidence interval:0.742-0.923).According to the score,the patients were divided into low-risk,intermediate-risk and highrisk groups.Overall survival and progression-free survival were significantly different between groups.CONCLUSION The AADN score can distinguish the prognostic risk of uHCC patients treated with TACE,sintilimab and lenvatinib,provides a basis for individualized treatment decision-making,and have clinical application prospect.展开更多
Colorectal cancer(CRC)with liver metastasis remains a significant therapeutic challenge,particularly in cases of postoperative recurrence.While transarterial chemoembolization(TACE)and targeted therapies have shown pr...Colorectal cancer(CRC)with liver metastasis remains a significant therapeutic challenge,particularly in cases of postoperative recurrence.While transarterial chemoembolization(TACE)and targeted therapies have shown promise individually,the efficacy combining these for treating postoperative recurrent CRC with liver metastasis requires further investigation.AIM To evaluate the efficacy and safety of TACE combined with targeted therapies for postoperative recurrent CRC with liver metastasis.METHODS This observational study enrolled 75 patients with postoperative recurrent CRC accompanied by liver metastasis between January 2020 and December 2023.All patients received combined treatment with TACE and targeted therapy:Bevacizumab(40 patients,53.3%),cetuximab(25 patients,33.3%),or panitumumab(10 patients,13.3%).Treatment response was evaluated using the Response Evaluation Criteria in Solid Tumors 1.1 criteria,with overall survival(OS)and progression-free survival as the primary endpoints.Quality of life was assessed using the European Organization for Research and Treatment of Cancer quality of life questionnaire at baseline and after six months of treatment.RESULTS The median OS was 28 months(95%confidence interval:24-32 months),and the median progression-free survival was 12 months(95%confidence interval:10-14 months).Patients treated with bevacizumab showed significantly better survival outcomes than those treated with cetuximab/panitumumab(median OS,30 vs 24 months,P=0.015).The overall response rate was 58.7%,with a disease control rate of 86.7%.Quality of life scores improved significantly across all domains,with greater improvements observed in the bevacizumab group.Treatment-related adverse events were manageable,with grade 3-4 events occurring in 13.3%of the patients and no treatment-related mortality.CONCLUSION The combination of TACE with targeted therapy,particularly bevacizumab,has demonstrated promising efficacy and acceptable safety for the treatment of postoperative recurrent CRC with liver metastasis.This multimodal approach not only improved survival outcomes but also enhanced the patients’quality of life,suggesting its potential as a valuable treatment strategy for this challenging condition.展开更多
BACKGROUND The combination of sorafenib with transarterial chemoembolization(TACE)is being investigated for its potential to improve outcomes in advanced hepatocellular carcinoma(HCC).AIM To evaluate the efficacy of t...BACKGROUND The combination of sorafenib with transarterial chemoembolization(TACE)is being investigated for its potential to improve outcomes in advanced hepatocellular carcinoma(HCC).AIM To evaluate the efficacy of this combined treatment strategy in enhancing overall survival(OS)and progression-free survival(PFS)compared to monotherapies.METHODS A systematic review was conducted following the PRISMA guidelines.A comprehensive search was performed across PubMed,EMBASE,Web of Science,and the Cochrane Library up to May 8,2024.Studies were included if they compared sorafenib plus TACE to sorafenib alone or TACE alone in adults with advanced HCC.Primary outcomes were OS,PFS,response rates,and safety profiles.Data extraction and quality assessment were independently performed by two reviewers.Heterogeneity was assessed using the I^(2)statistic,and a random-effects model was applied for pooling data.Sensitivity analysis and publication bias assessment were also conducted.RESULTS A total of twelve studies involving 1174 patients met the inclusion criteria.Significant heterogeneity was observed for both OS(I^(2)=72.6%,P<0.001)and PFS(I^(2)=83.7%,P<0.001).The combined treatment of sorafenib with TACE significantly improved OS[hazard ratio(HR)=0.60,95%confidence interval(CI):0.44-0.76]and PFS(HR=0.54,95%CI:0.38-0.69).Sensitivity analysis confirmed the robustness of these findings.Funnel plots and Egger's test indicated no significant publication bias.CONCLUSION Sorafenib combined with TACE significantly enhances both OS and PFS in patients with advanced HCC compared to monotherapy.This combination therapy represents a promising approach to improving clinical outcomes in advanced liver cancer.展开更多
To the Editor:We read with great interest the recent article by Shi et al.pub-lished in Hepatobiliary Pancreatic Diseases International[1].Shi’s study was based on radiological features and clinical factors to constr...To the Editor:We read with great interest the recent article by Shi et al.pub-lished in Hepatobiliary Pancreatic Diseases International[1].Shi’s study was based on radiological features and clinical factors to construct a model to predict the effectiveness of first transarterial chemoembolization(TACE)treatment for hepatocellular carcinoma(HCC)in prolonging patient survival.The results showed that area under the receiver operating characteristic curve was 0.964 for the training cohort and 0.949 for the validation cohort.展开更多
Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to...Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to recanalization and neoangiogenesis,which may interfere with the synergistic effects of combination therapy.This study aimed to investigate whether TACE simultaneously combined with microwave ablation(MWA)is more effective than sequential therapy in patients with HCC.Methods:A total of 129 HCC patients who underwent TACE combined with MWA were included in this study.Based on the time interval between the first combination therapy of TACE and MWA,patients were divided into the simultaneous and sequential groups.Propensity score matching(PSM)was performed to reduce bias between the groups.Overall survival(OS),time-to-progression(TTP),tumor response,and liver function were compared.Results:Before PSM,the simultaneous group had a higher tumor load.Following PSM,36 and 40 patients remained in the simultaneous and sequential groups,respectively.The median TTP and OS were 12.9 vs.10.6 months(P=0.262)and 44.0 vs.26.5 months(P=0.313)for the simultaneous and sequential groups,respectively.After 4–8 weeks,there were 16 complete responders and 17 partial responders in the simultaneous group and 15 and 22 patients in the sequential group,respectively(P=0.504).The median complete response duration was 11.3 and 9.2 months for the simultaneous and sequential groups,respectively(P=0.882).These results did not differ in BCLC stratified subgroups.Patients with small tumor sizes(≤5 cm),tumor nodules≤3,well-defined boundaries,and early-stage tumors were more likely to achieve complete response(all P<0.05).After 4–8 weeks,the liver function was significantly improved compared to that before or one day after treatment.Conclusions:TACE simultaneously combined with MWA is safe and effective but not superior to sequential therapy.展开更多
BACKGROUND Transcatheter arterial chemoembolization(TACE)combined with lenvatinib is an important modality for the treatment of unresectable hepatocellular carcinoma(HCC).To date,no prognostic analysis exists for clin...BACKGROUND Transcatheter arterial chemoembolization(TACE)combined with lenvatinib is an important modality for the treatment of unresectable hepatocellular carcinoma(HCC).To date,no prognostic analysis exists for clinical predictive models of TACE combined with lenvatinib in treating advanced unresectable HCC.A model was constructed through meta-analysis,and its validation was further enhanced by the collection of external clinical data,thereby providing guidance for clinical practice.AIM To identify risk factors for unresectable HCC following TACE plus lenvatinib therapy and to construct a clinical prediction model.METHODS We searched PubMed,Web of Science,EMBASE,and Cochrane Library databases for studies on TACE plus lenvatinib for unresectable HCC.Risk factors from the meta-analysis and sensitivity analyses were used to construct a prediction model.The validation set included clinical data from 106 eligible patients at the Affiliated Hospital of North Sichuan Medical College collected by June 1,2023.RESULTS This study included 43 group studies involving 5070 patients.Tumor number,microvascular invasion,Eastern Cooperative Oncology Group performance status,Child-Pugh stage,Barcelona Clinic Liver Cancer stage,extra-hepatic metastases,alpha-fetoprotein level,and hepatitis B virus status were risk factors for overall survival and progression-free survival,while triple therapy was a protective factor for both.In the validation set,the overall survival prediction model had area under the curve values of 0.616,0.643,and 0.706 at 1 year,2 years,and 3 years,respectively,and the progression-free survival model had area under the curve values of 0.702,0.696,and 0.670 at the corresponding time points,demonstrating good model performance.Calibration curves,Kaplan-Meier survival analysis,and decision curves further validated the efficacy of the model.CONCLUSION Models based on nine variables from 43 group studies predicted the efficacy of TACE plus lenvatinib in unresectable HCC,supporting evidence-based clinical decisions and treatment strategies.展开更多
BACKGROUND Currently,there is a notable lack of reliable studies evaluating the impact of multidisciplinary treatment strategies following transarterial chemoembolization(TACE)on patients with hepatocellular carcinoma...BACKGROUND Currently,there is a notable lack of reliable studies evaluating the impact of multidisciplinary treatment strategies following transarterial chemoembolization(TACE)on patients with hepatocellular carcinoma(HCC),underscoring the urgent need for higher-level research in this area.AIM To investigate the association of multidisciplinary treatment strategies with the immunological,coagulation,and tumor biomarker responses after post-TACE in HCC.METHODS This retrospective analysis included 100 patients with HCC who were categorized based on the treatment approach into the control(patients treated with TACE alone)and experimental groups(patients receiving multidisciplinary treatment strategies post-TACE).Participant characteristics,short-term efficacy,and safety assessment as well as immunological,coagulation,and tumor biomarker res-ponses between the two groups were collected and compared.RESULTS Compared with the control group,the experimental group demonstrated a superior overall response rate,along with an increased fibrinogen,markedly improved immunological biomarker,lower prothrombin time,thrombin time,alpha-fetoprotein,carcinoembryonic antigen,and carbohydrate antigen 199 levels,as well as a decreased abnormal prothrombin incidence,and a lower overall rate of adverse reactions.Notably,no significant difference in the activated partial thromboplastin time and D-dimer levels was observed between the two groups.CONCLUSION Multidisciplinary treatment strategies post-TACE have improved the treatment outcome,the immunological response,and the coagulation function,lowered the tumor biomarker response levels,and reduced the risk of adverse reactions in patients with HCC.展开更多
BACKGROUND Hepatic hemangiomas represent the most prevalent benign liver tumors.Surgical management of large symptomatic hepatic hemangiomas remains controversial and there is an increasing interest in minimally invas...BACKGROUND Hepatic hemangiomas represent the most prevalent benign liver tumors.Surgical management of large symptomatic hepatic hemangiomas remains controversial and there is an increasing interest in minimally invasive techniques,such as transcatheter arterial chemoembolization(TACE)and microwave ablation(MWA).AIM To evaluate the efficacy and safety of TACE combined with MWA for large hepatic hemangiomas.METHODS This retrospective cohort study was conducted at Peking Union Medical College Hospital between January 2015 and January 2024.Eighty-two patients with hepatic hemangiomas>5 cm were divided into two groups:Observation(TACE+MWA,n=50)and control(TACE,n=32).Tumor diameter and treatment outcomes were evaluated at baseline,12 months,and>3 years.Appropriate statistical tests were chosen based on the type and distribution of the data.RESULTS At baseline,the median tumor diameter was 8.3(range:5.0-19.2)cm in the observation group and 8.5(range:5.0-20.0)cm in the control group.The median follow up duration was 44.6(95%confidence interval:36.7-52.5)months.At 12 months post-treatment,the observation group demonstrated a higher tumor reduction ratio compared to the control group(50.98%vs 23.28%,respectively;P<0.001).The objective response rate was 93.94%in the observation group,which was significantly higher than that in the control group(33.33%)(P<0.001).No recurrence occurred in the observation group,while one case occurred in the control group.Notably,no cases of hemoglobinuria or acute kidney injury were reported in the observation group.CONCLUSION Combination treatment enhances tumor shrinkage,promotes long-term tumor control,and reduces the complications associated with MWA,thereby presenting a promising alternative to surgical resection.展开更多
In this article we commented on an article published recently by Jiao et al.This retrospective study confirmed that the triple therapy of transarterial chemoembolization(TACE)combined with programmed death protein lig...In this article we commented on an article published recently by Jiao et al.This retrospective study confirmed that the triple therapy of transarterial chemoembolization(TACE)combined with programmed death protein ligand 1 inhibitors and molecular targeted therapy can significantly reverse TACE resistance in advanced hepatocellular carcinoma.Compared with TACE alone,the triple therapy reduced the resistance rate from 38.8%to 9.7%and increased the median progression-free survival and median overall survival by 92.3%and 26.8%,respectively.TACE induces tumor antigen release and upregulates programmed death protein ligand 1,activating the effect of immune checkpoint inhibitors while molecular targeted therapy inhibits postembolization vascular regeneration,forming a dynamic synergistic network of embolization-immune activation-vascular inhibition.The maximum tumor diameter,capsule loss,and bilateral distribution were identified as independent predictors.This study provided level I evidence and promoted the transformation of advanced hepatocellular carcinoma treatment from single local intervention to an integrated model of local control-systemic treatment.In the future it will be necessary to analyze the dynamic evolution rules of the tumor microenvironment through crossomics strategies,further explore biomarkers,optimize treatment sequences,and conduct multicenter prospective trials to verify long-term survival benefits and guide the optimization of individualized sequential treatment.展开更多
BACKGROUND Sub-Saharan Africa(SSA)and Southeast Asia account for 80%of hepatocellular carcinoma(HCC)cases globally.Public healthcare systems in low-and middleincome countries often face significant economic constraint...BACKGROUND Sub-Saharan Africa(SSA)and Southeast Asia account for 80%of hepatocellular carcinoma(HCC)cases globally.Public healthcare systems in low-and middleincome countries often face significant economic constraints,resulting in limited treatment options.The objectives of this study were to identify factors associated with poor outcomes in patients with Barcelona Clinic Liver Cancer(BCLC)stage C and D undergoing transarterial chemoembolization(TACE)and to compare their outcomes to patients treated tyrosine kinase inhibitors(TKIs)or best supportive care(BSC)only.AIM To assess clinical outcomes and identify predictive factors that may facilitate the broader implementation of TACE in patients with advanced HCC within resource-constrained settings such as SSA.METHODS A single-center,retrospective cohort study was conducted to investigate the risk factors associated with the outcome of TACE in patients with BCLC stage C and D using univariate and multivariate regression analysis.Frequency matching was used to ensure comparable distributions of confounding factors across patients treated with TACE,TKIs,or BSC.Survival analysis was performed to compare outcomes among the matched groups.RESULTS Patients with BCLC stage C and D presenting with elevated gamma-glutamyl transferase levels or elevated aspartate aminotransferase levels or portal vein infiltration were identified as high-risk and demonstrated poor response to TACE treatment.In contrast,patients with BCLC stage C disease who lacked these highrisk features showed significantly longer overall survival when treated with TACE compared to those who received BSC or TKIs.CONCLUSION Gamma-glutamyl transferase levels,aspartate aminotransferase levels,and portal vein infiltration are critical risk factors to consider when determining treatment strategies for HCC patients in SSA.Patients without these factors can derive significant benefits from TACE as an alternative to BSC or TKIs.展开更多
基金supported by grants from the National Natural Science Foundation of China(91959203,82272836 and 82373017)。
文摘Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarterial chemoembolization(TACE)as an adjuvant therapy in HCC patients with high risk of recurrence.Methods:Patients were enrolled from eight hepatobiliary centers in China.The primary endpoint was disease-free survival(DFS).The secondary endpoints were overall survival(OS)and safety.Additionally,propensity score matching(PSM)and other three propensity score analyses were performed to balance the potential baseline bias to validate the conclusion.The adverse events(AEs)were recorded throughout the study.The study was registered at Clinical Trials.gov(NCT03838796).Results:A total of 297 patients were enrolled,with 147 in the LEN+TACE group and 150 in the TACE group.Before PSM,the LEN+TACE group achieved significantly better DFS than the TACE group(19.0 vs.10.0 months,P=0.011).PSM analysis identified 111 matched pairs.After PSM,the LEN+TACE group also showed better DFS(19.0 vs.9.0 months,P=0.018).Other three propensity score analyses yielded similar DFS benefit tendency.Furthermore,favorable OS was also obtained in the LEN+TACE group before PSM.Lenvatinib related AEs of grade 3 or 4 occurred in 28.6%of the patients in the LEN+TACE group.Conclusions:Adjuvant lenvatinib plus TACE might be a promising adjuvant approach for HCC patients with high risk of recurrence,which could significantly prolong DFS and potentially OS with a manageable safety profile.
文摘Hepatocellular carcinoma(HCC)remains one of the most common cancers worldwide.Transcatheter arterial chemoembolization has become a common treatment modality for some patients with unresectable advanced HCC.Since the introduction of nanomaterials in 1974,their use in various fields has evolved rapidly.In medical applications,nanomaterials can serve as carriers for the delivery of chemotherapeutic drugs to tumour tissues.Additionally,nanomaterials have potential for in vivo tumour imaging.This article covers the properties and uses of several kinds of nanomaterials,focusing on their use in transcatheter arterial chemoembolization for HCC treatment.This paper also discusses the limitations currently associated with the use of nanomaterials.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a common tumor with a poor prognosis.Early intervention is essential;thus,good prognostic markers to identify patients who benefit from first transarterial chemoembolization(TACE)are needed.AIM To investigate the efficacy of computed tomography(CT)radiomics in predicting the success of the first TACE in patients with advanced HCC and to develop an early prediction model based on clinical radiomics features.METHODS Data from 122 patients with advanced HCC treated with TACE were analyzed.Intratumoral and peritumoral areas on arterial and venous CT images were selected to extract radiomic features,which were screened in the training cohort using the minimum redundancy maximum correlation.Then,support vector machines were used to construct the model.To construct a receiver operating characteristic curve,the predictive efficacy of each model was evaluated on the basis of the area under the curve(AUC).RESULTS Among the 122 patients,72 patients were effectively treated via TACE,and in 50 patients,this treatment was ineffective.In the radiomics model,the areas under the curve of the venous phase model were 0.867(95%CI:0.790-0.940)in the training cohort and 0.755(0.600-0.910)in the validation cohort,indicating good predictive efficacy.The multivariate logistic regression results indicated that preoperative alpha-fetoprotein levels(P=0.01)were a risk factor for TACE.The screened clinical features were combined with the radiomic features to construct a combined model.This combined model had an AUC of 0.92(0.87-0.95)in the training cohort and 0.815(0.67-0.95)in the validation cohort.CONCLUSION CT radiomics has good value in predicting the efficacy of the first TACE treatment in patients with HCC.The combined model was a better tool for predicting the first TACE efficacy in patients with advanced HCC and could provide an efficient predictive tool to help with the selection of patients for TACE.
文摘BACKGROUND Transcatheter arterial chemoembolization(TACE)is a key treatment approach for advanced invasive liver cancer(infiltrative hepatocellular carcinoma).However,its therapeutic response can be difficult to evaluate accurately using conventional two-dimensional imaging criteria due to the tumor’s diffuse and multifocal growth pattern.Volumetric imaging,especially enhanced tumor volume(ETV),offers a more comprehensive assessment.Nonetheless,bias field inhomogeneity in magnetic resonance imaging(MRI)poses challenges,potentially skewing volumetric measurements and undermining prognostic evaluation.AIM To investigate whether MRI bias field correction enhances the accuracy of volumetric assessment of infiltrative hepatocellular carcinoma treated with TACE,and to analyze how this improved measurement impacts prognostic prediction.METHODS We retrospectively collected data from 105 patients with invasive liver cancer who underwent TACE treatment at the Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2024.The improved N4 bias field correction algorithm was applied to process MRI images,and the ETV before and after treatment was calculated.The ETV measurements before and after correction were compared,and their relationship with patient prognosis was analyzed.A Cox proportional hazards model was used to evaluate prognostic factors,with Martingale residual analysis determining the optimal cutoff value,followed by survival analysis.RESULTS Bias field correction significantly affected ETV measurements,with the corrected baseline ETV mean(505.235 cm^(3))being significantly lower than before correction(825.632 cm^(3),P<0.001).Cox analysis showed that the hazard ratio(HR)for corrected baseline ETV(HR=1.165,95%CI:1.069-1.268)was higher than before correction(HR=1.063,95%CI:1.031-1.095).Using 412 cm^(3) as the cutoff,the group with baseline ETV<415 cm^(3) had a longer median survival time compared to the≥415 cm^(3) group(18.523 months vs 8.926 months,P<0.001).The group with an ETV reduction rate≥41%had better prognosis than the<41%group(17.862 months vs 9.235 months,P=0.006).Multivariate analysis confirmed that ETV reduction rate(HR=0.412,P<0.001),Child-Pugh classification(HR=0.298,P<0.001),and Barcelona Clinic Liver Cancer stage(HR=0.578,P=0.045)were independent prognostic factors.CONCLUSION Volume imaging based on MRI bias field correction can improve the accuracy of evaluating the efficacy of TACE treatment for invasive liver cancer.The corrected ETV and its reduction rate can serve as independent indicators for predicting patient prognosis,providing important reference for developing individualized treatment strategies.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is the most common form of liver cancer that has limited treatment options and a poor prognosis.Transarterial chemoembolization(TACE)is the first-line treatment for intermediate-stage HCC but can induce tumour hypoxia,thereby promoting angiogenesis.Recent studies suggested that combining TACE with anti-angiogenic therapies and immunotherapy might im-prove efficacy.Lenvatinib,a tyrosine kinase inhibitor,has demonstrated superior outcomes compared to sorafenib,while immune checkpoint inhibitors such as sintilimab show potential when combined with TACE.However,the efficacy and safety of TACE combined with lenvatinib and sintilimab(TACE+SL)compared to TACE with lenvatinib alone(TACE+L)in patients with intermediate-ad-vanced HCC has not yet been investigated.AIM To evaluate the efficacy and safety of TACE+SL therapy in comparison to TACE+L therapy in patients with intermediate-advanced HCC.METHODS A retrospective analysis was performed on patients with intermediate-advanced HCC who received TACE plus lenvatinib with or without sintilimab between September 2019 and September 2022.Baseline characteristics were compared,and propensity score matching was applied.Overall survival(OS),progression-free survival(PFS),and objective response rate(ORR)were evaluated between the two groups,and adverse events were analyzed.RESULTS The study included 57 patients,with 30 in the TACE+SL group and 27 in the TACE+L group.The TACE+SL group demonstrated significantly improved median PFS and OS compared to the TACE+L group(PFS:14.1 months vs 9.6 months,P=0.016;OS:22.4 months vs 14.1 months,P=0.039),along with a higher ORR(70.0%vs 55.6%).After propensity score matching,30 patients were included,with the TACE+SL group again showing longer median PFS and a trend toward improved OS(PFS:14.6 months vs 9.2 months,P=0.012;OS:23.9 months vs 16.3 months,P=0.063),and a higher ORR(73.3%vs 53.3%).No severe adverse events were reported.CONCLUSION TACE+SL demonstrated superior outcomes in terms of OS and PFS,compared to TACE+L.These findings suggest that the addition of sintilimab might enhance the therapeutic response in patients with intermediate-advanced HCC.
文摘BACKGROUND Transarterial chemoembolization(TACE)is a widely accepted palliative therapy modality for unresectable hepatocellular carcinoma(HCC).Although it is rarely curative,complete radiological response can be achieved in selected patients,leading to prolonged survival.Post-treatment tumoral calcification is an uncom-mon imaging finding in HCC and is rarely reported after drug-eluting beads TACE(DEB-TACE).CASE SUMMARY Two patients with large,solitary HCCs(>5 cm)were treated with DEB-TACE,and both achieved complete radiological response after two treatment sessions.Approximately 1 year after DEB-TACE,imaging demonstrated progressive peripheral tumoral calcification.Over 6 years of follow-up,both patients remained in remission with preserved liver function.CONCLUSION These two cases highlight the potential for complete remission and long-term survival in selected patients with large HCC following DEB-TACE.The appearance of peripheral calcification may represent a late imaging marker of effective tumor necrosis and durable treatment response although prospective studies are warranted to clarify its prognostic value.
基金Supported by the Guangzhou Science and Technology Plan Project,No.2023A04J0419National Natural Science Foundation Cultivation Project at the Third Affiliated Hospital of Sun Yat-sen University,No.2022GZRPYQN04.
文摘BACKGROUND Intrahepatic cholangiocarcinoma(iCCA)is the second most common liver malignancy with poor prognosis and limited treatment options.AIM To identify the most effective drug for transarterial chemoembolization(TACE)in cholangiocarcinoma and evaluate the efficacy and safety of combining it with gemcitabine and cisplatin(GemCis)for unresectable iCCA.METHODS Cholangiocarcinoma cell lines(RBE,HuCC-T1)were treated with 10 chemotherapeutic drugs,and cytotoxicity was assessed by cell counting kit-8 assays.Tumorbearing nude mice were treated with idarubicin or GemCis,and tumor growth was monitored.Clinical data from 85 iCCA patients were analyzed to evaluate the efficacy and safety of idarubicin-TACE combined with GemCis.RESULTS Idarubicin demonstrated the highest cytotoxicity,significantly outperforming GemCis,the standard first-line therapies.In tumor-bearing mouse models,idarubicin and GemCis treatments significantly slowed tumor growth,with idarubicin showing particularly pronounced effects on days 12 and 15(P<0.05).In retrospective analysis,the median overall survival(OS)and progression-free survival(PFS)in the combination therapy group were significantly longer than those in the GemCis alone group(median OS,16.23 months vs 10.07 months,P=0.042;median PFS,7.73 months vs 6.30 months,P=0.023).Additionally,major grade 3/4 adverse events(AEs)in the combination therapy group were abdominal pain(26.3%vs 6.5%,P=0.049)and elevated transaminases(42.1%vs 12.9%,P=0.038).Most AEs were mild to moderate and manageable.CONCLUSION Idarubicin demonstrated higher cytotoxicity than GemCis,significantly inhibiting tumor growth in tumor-bearing mouse models.Preliminary clinical results suggest that local idarubicin-TACE combined with GemCis may offer improved survival outcomes for iCCA patients with a manageable safety profile.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide and currently lacks effective treatment options.This is particularly true for advanced HCC,for which conventional therapies often lead to a poor prognosis.AIM To assess the safety and efficacy of transarterial chemoembolization(TACE)with donafenib and immune checkpoint inhibitors(ICIs)for unresectable HCC.METHODS We retrospectively assessed the data of patients with HCC who underwent TACE combined with donafenib and an ICI(tislelizumab or cedilimumab).Patients received oral donafenib daily for 2 weeks before TACE,followed by tislelizumab or cedilimumab 200 mg intravenously on day 1 of a 21-day therapeutic cycle.The primary endpoints were objective response rate,disease control rate,and duration of response according to the modified RECIST criteria.The secondary endpoint was presence of treatment-related adverse events(TRAEs).RESULTS The median follow-up was 7.8 months(95%CI:5.0-11.8 months).The objective response rate was 60.0%(18/30),while the disease control rate was 93.3%.The median duration of response in confirmed responders was 6.6 months(95%CI:1.3-12.9 months).The median progression-free survival was 11.8 months(95%CI:8.3-15.4 months).More than half of the patients survived until the end of the study.Grade>3 TRAEs occurred in 40%of the patients with no grade 5 TRAEs reported.The most common grade 3/4 TRAE was palmar-plantar erythrodysesthesia,a dermatologic condition characterized by painful redness and swelling of the palms and soles,with an incidence of 56.7%.No ICI-related adverse effects were observed.CONCLUSION TACE combined with donafenib and ICI is a promising and safe therapeutic regimen for unresectable HCC.
基金Supported by the Shenzhen High-Level Hospital Construction Fund,the Sanming Project of Medicine in Shenzhen,No.SZSM202011010Intramural Research Projects of Shenzhen Hospital,Cancer Hospital,Chinese Academy of Medical Sciences,No.SZ2020MS010the Scientific Research Program Fund of Hunan Provincial Health Commission,No.202204014693.
文摘BACKGROUND Lenvatinib and sorafenib are tyrosine kinase inhibitors that are effective in the treatment of unresectable hepatocellular carcinoma(uHCC).The efficacy of which of them is better suited to combine transarterial chemoembolization(TACE)for the treatment of uHCC is ripe.RESULTS A total of six studies involving 547 patients were included,248 in the TACE-lenvatinib group and 299 in the TACE-sorafenib group.Meta-analysis results showed that TACE-lenvatinib was more effective than TACE-sorafenib in complete response[relative risk(RR)=1.81,95%confidence interval(CI):1.11-2.96,P=0.02],partial response(RR=1.38,95%CI:1.12-1.70,P=0.002),objective response rate(RR=1.47,95%CI:1.24-1.74,P<0.0001)and disease control rate(RR=1.22,95%CI:1.00-1.49,P=0.05).TACE-lenvatinib was significantly lower than TACE-sorafenib in progressive disease rate(RR=0.54,95%CI:0.39-0.74,P=0.002).No significant difference was found in stable disease rate(RR=0.89,95%CI:0.60-1.33,P=0.58)between the two groups.TACE-lenvatinib was significantly more effective than TACE-sorafenib in overall survival(hazard ratio=2.00,95%CI:1.59-2.50,P<0.05)and progression free survival(hazard ratio=2.04,95%CI:1.49-2.86,P<0.05).As regards adverse events,TACE-lenvatinib was better in reducing the incidence of hypertension than TACE-sorafenib,while no significant difference was found in overall adverse events,abdominal pain,fever,fatigue,nausea and vomiting,decreased appetite,liver dysfunction,hand-foot skin reaction,diarrhea,thrombocytopenia,and rash between the two groups.CONCLUSION In patients with uHCC,TACE-lenvatinib induced a better tumor response rate and survival outcome than TACE-sorafenib,while TACE-lenvatinib resulted in a higher incidence of hypertension than TACE-sorafenib.However,these conclusions are derived from currently available medical evidence,and further confirmation by more rigorously designed randomized controlled studies is still needed.
基金Supported by Faculty of Medicine Vajira Hospital,Navamindradhiraj University Research Fund,No.1-67.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a major health concern in Thailand,with most patients diagnosed at the intermediate stage.Transarterial chemoembolization(TACE)is the standard treatment;however,postembolization syndrome(PES)remains a common complication.Although both dexamethasone(DEXA)and N-acetylcysteine(NAC)have shown efficacy in reducing PES,no study has directly compared their effects.AIM To compare the incidence of PES between DEXA and NAC in intermediate-stage HCC patients undergoing conventional TACE(cTACE).METHODS A randomized,double-blind,controlled trial was conducted at two tertiary hospitals in Thailand from November 2024 to April 2025.Eligible HCC patients(aged 18-70 years)were randomized(1:1)to receive either NAC(150 mg/kg/hour loading dose,followed by 50 mg/kg over 4 hours,then 6.25 mg/kg/hour for 48 hours post-cTACE)or DEXA(8 mg IV 1 hour before cTACE).cTACE was performed by blinded interventional radiologists.The primary outcome was PES occurrence within 48 hours,assessed using South West Oncology Group toxicity coding and the Common Terminology Criteria for Adverse Events.The secondary outcomes were post-cTACE liver decompensation and the dynamic changes in the albumin-bilirubin(ALBI)score.RESULTS A total of 56 intermediate-stage HCC patients were included(DEXA,n=28;NAC,n=28).Most had preserved liver function,with 92.9%classified as Child-Pugh A.The maximum tumor size was 6.2 cm,and 85.7%had multiple lesions.Additionally,39 patients(69.6%)met the beyond up-to-7 criteria.Overall,27 patients(48.2%)developed PES.After adjusting for confounding factors,the NAC group had a significantly lower incidence of PES than the DEXA group(32.1%vs 64.3%;adjusted odds ratio=0.17,95%confidence interval:0.03-0.87,P=0.033).Only two patients(3.6%)developed post-cTACE liver decompensation.Furthermore,51.8%patients experienced worsening ALBI scores within 48 hours post-procedure;however,the rate of ALBI score worsening did not significantly differ between the groups.CONCLUSION Compared with DEXA,NAC significantly reduces the incidence of PES,regardless of its impact on liver function recovery.Therefore,NAC is a preferable option for reducing PES in Barcelona Clinic Liver Cancer-B stage HCC patients with preserved liver function.
基金Supported by National Key Sci-Tech Special Project of China,No.2018ZX10302207Beijing Nova Program,No.20250484965+4 种基金Beijing Natural Science Foundation,No.7222191 and No.7244426Fundamental Research Funds for the Central Universities,Peking University,No.PKU2024XGK005Peking University Medicine Seed Fund for Interdisciplinary Research,No.BMU2021MX007 and No.BMU2022MX001Fundamental Research Funds for the Central Universities,Peking University People’s Hospital Scientific Research Development Funds,No.RDX2020-06 and No.RDJ2022-14the Qi-Min Project.
文摘BACKGROUND Although the triple therapy of transarterial chemoembolization(TACE)combined with immune checkpoint inhibitors and tyrosine kinase inhibitors is becoming an effective treatment for unresectable hepatocellular carcinoma(uHCC).However,there is still a lack of effective tools for predicting therapeutic effects at present.AIM To develop a predictive tool for the prognosis of uHCC patients treated with TACE,sintilimab and lenvatinib.METHODS Based on multicenter data,this study constructed and validated an AADN score as variables to predict overall survival in patients treated with this combination therapy.This study included 188 uHCC cases(training cohort:n=101,validation cohort:n=87)from three different hospitals.Who were treated with TACE,sintilimab and lenvatinib.RESULTS In multivariate analysis,alpha-fetoprotein≥100 ng/mL[hazard ratio(HR)=2.579,P=0.010],alkaline phosphatase>120 U/L,(HR=2.234,P=0.021),direct bilirubin>7.3μmol/L(HR=2.931,P=0.007)and neutrophil to lymphocyte ratio>2.5(HR=3.127,P=0.006)were identified as independent prognostic factors and were used to establish the AADN score.Kaplan-Meier survival curves and time-dependent receiver operating characteristic curves were used to assess the accuracy of the AADN score,with area under receiver operating characteristic curve values of 0.827(training cohort,95%confidence interval:0.743-0.911)and 0.832(validation cohort,95%confidence interval:0.742-0.923).According to the score,the patients were divided into low-risk,intermediate-risk and highrisk groups.Overall survival and progression-free survival were significantly different between groups.CONCLUSION The AADN score can distinguish the prognostic risk of uHCC patients treated with TACE,sintilimab and lenvatinib,provides a basis for individualized treatment decision-making,and have clinical application prospect.
基金Supported by 2023 Hebei Provincial Medical Scientific Research Project Plan,No.20231304.
文摘Colorectal cancer(CRC)with liver metastasis remains a significant therapeutic challenge,particularly in cases of postoperative recurrence.While transarterial chemoembolization(TACE)and targeted therapies have shown promise individually,the efficacy combining these for treating postoperative recurrent CRC with liver metastasis requires further investigation.AIM To evaluate the efficacy and safety of TACE combined with targeted therapies for postoperative recurrent CRC with liver metastasis.METHODS This observational study enrolled 75 patients with postoperative recurrent CRC accompanied by liver metastasis between January 2020 and December 2023.All patients received combined treatment with TACE and targeted therapy:Bevacizumab(40 patients,53.3%),cetuximab(25 patients,33.3%),or panitumumab(10 patients,13.3%).Treatment response was evaluated using the Response Evaluation Criteria in Solid Tumors 1.1 criteria,with overall survival(OS)and progression-free survival as the primary endpoints.Quality of life was assessed using the European Organization for Research and Treatment of Cancer quality of life questionnaire at baseline and after six months of treatment.RESULTS The median OS was 28 months(95%confidence interval:24-32 months),and the median progression-free survival was 12 months(95%confidence interval:10-14 months).Patients treated with bevacizumab showed significantly better survival outcomes than those treated with cetuximab/panitumumab(median OS,30 vs 24 months,P=0.015).The overall response rate was 58.7%,with a disease control rate of 86.7%.Quality of life scores improved significantly across all domains,with greater improvements observed in the bevacizumab group.Treatment-related adverse events were manageable,with grade 3-4 events occurring in 13.3%of the patients and no treatment-related mortality.CONCLUSION The combination of TACE with targeted therapy,particularly bevacizumab,has demonstrated promising efficacy and acceptable safety for the treatment of postoperative recurrent CRC with liver metastasis.This multimodal approach not only improved survival outcomes but also enhanced the patients’quality of life,suggesting its potential as a valuable treatment strategy for this challenging condition.
基金Supported by Sichuan Science and Technology Program,No.2022YFS0625。
文摘BACKGROUND The combination of sorafenib with transarterial chemoembolization(TACE)is being investigated for its potential to improve outcomes in advanced hepatocellular carcinoma(HCC).AIM To evaluate the efficacy of this combined treatment strategy in enhancing overall survival(OS)and progression-free survival(PFS)compared to monotherapies.METHODS A systematic review was conducted following the PRISMA guidelines.A comprehensive search was performed across PubMed,EMBASE,Web of Science,and the Cochrane Library up to May 8,2024.Studies were included if they compared sorafenib plus TACE to sorafenib alone or TACE alone in adults with advanced HCC.Primary outcomes were OS,PFS,response rates,and safety profiles.Data extraction and quality assessment were independently performed by two reviewers.Heterogeneity was assessed using the I^(2)statistic,and a random-effects model was applied for pooling data.Sensitivity analysis and publication bias assessment were also conducted.RESULTS A total of twelve studies involving 1174 patients met the inclusion criteria.Significant heterogeneity was observed for both OS(I^(2)=72.6%,P<0.001)and PFS(I^(2)=83.7%,P<0.001).The combined treatment of sorafenib with TACE significantly improved OS[hazard ratio(HR)=0.60,95%confidence interval(CI):0.44-0.76]and PFS(HR=0.54,95%CI:0.38-0.69).Sensitivity analysis confirmed the robustness of these findings.Funnel plots and Egger's test indicated no significant publication bias.CONCLUSION Sorafenib combined with TACE significantly enhances both OS and PFS in patients with advanced HCC compared to monotherapy.This combination therapy represents a promising approach to improving clinical outcomes in advanced liver cancer.
基金supported by a grant from the Nursing Re-search Program of the First Affiliated Hospital of Zhejiang Univer-sity School of Medicine(No.2022ZYHL045).
文摘To the Editor:We read with great interest the recent article by Shi et al.pub-lished in Hepatobiliary Pancreatic Diseases International[1].Shi’s study was based on radiological features and clinical factors to construct a model to predict the effectiveness of first transarterial chemoembolization(TACE)treatment for hepatocellular carcinoma(HCC)in prolonging patient survival.The results showed that area under the receiver operating characteristic curve was 0.964 for the training cohort and 0.949 for the validation cohort.
基金supported by grants from Guangzhou Sci-ence and Technology Bureau City-University(College)Joint Fund-ing Project(2023A03J0224)2024 Guangzhou Basic and Applied Basic Research Scheme(Project for Maiden Voyage)(SL2023A04J00258)。
文摘Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to recanalization and neoangiogenesis,which may interfere with the synergistic effects of combination therapy.This study aimed to investigate whether TACE simultaneously combined with microwave ablation(MWA)is more effective than sequential therapy in patients with HCC.Methods:A total of 129 HCC patients who underwent TACE combined with MWA were included in this study.Based on the time interval between the first combination therapy of TACE and MWA,patients were divided into the simultaneous and sequential groups.Propensity score matching(PSM)was performed to reduce bias between the groups.Overall survival(OS),time-to-progression(TTP),tumor response,and liver function were compared.Results:Before PSM,the simultaneous group had a higher tumor load.Following PSM,36 and 40 patients remained in the simultaneous and sequential groups,respectively.The median TTP and OS were 12.9 vs.10.6 months(P=0.262)and 44.0 vs.26.5 months(P=0.313)for the simultaneous and sequential groups,respectively.After 4–8 weeks,there were 16 complete responders and 17 partial responders in the simultaneous group and 15 and 22 patients in the sequential group,respectively(P=0.504).The median complete response duration was 11.3 and 9.2 months for the simultaneous and sequential groups,respectively(P=0.882).These results did not differ in BCLC stratified subgroups.Patients with small tumor sizes(≤5 cm),tumor nodules≤3,well-defined boundaries,and early-stage tumors were more likely to achieve complete response(all P<0.05).After 4–8 weeks,the liver function was significantly improved compared to that before or one day after treatment.Conclusions:TACE simultaneously combined with MWA is safe and effective but not superior to sequential therapy.
文摘BACKGROUND Transcatheter arterial chemoembolization(TACE)combined with lenvatinib is an important modality for the treatment of unresectable hepatocellular carcinoma(HCC).To date,no prognostic analysis exists for clinical predictive models of TACE combined with lenvatinib in treating advanced unresectable HCC.A model was constructed through meta-analysis,and its validation was further enhanced by the collection of external clinical data,thereby providing guidance for clinical practice.AIM To identify risk factors for unresectable HCC following TACE plus lenvatinib therapy and to construct a clinical prediction model.METHODS We searched PubMed,Web of Science,EMBASE,and Cochrane Library databases for studies on TACE plus lenvatinib for unresectable HCC.Risk factors from the meta-analysis and sensitivity analyses were used to construct a prediction model.The validation set included clinical data from 106 eligible patients at the Affiliated Hospital of North Sichuan Medical College collected by June 1,2023.RESULTS This study included 43 group studies involving 5070 patients.Tumor number,microvascular invasion,Eastern Cooperative Oncology Group performance status,Child-Pugh stage,Barcelona Clinic Liver Cancer stage,extra-hepatic metastases,alpha-fetoprotein level,and hepatitis B virus status were risk factors for overall survival and progression-free survival,while triple therapy was a protective factor for both.In the validation set,the overall survival prediction model had area under the curve values of 0.616,0.643,and 0.706 at 1 year,2 years,and 3 years,respectively,and the progression-free survival model had area under the curve values of 0.702,0.696,and 0.670 at the corresponding time points,demonstrating good model performance.Calibration curves,Kaplan-Meier survival analysis,and decision curves further validated the efficacy of the model.CONCLUSION Models based on nine variables from 43 group studies predicted the efficacy of TACE plus lenvatinib in unresectable HCC,supporting evidence-based clinical decisions and treatment strategies.
文摘BACKGROUND Currently,there is a notable lack of reliable studies evaluating the impact of multidisciplinary treatment strategies following transarterial chemoembolization(TACE)on patients with hepatocellular carcinoma(HCC),underscoring the urgent need for higher-level research in this area.AIM To investigate the association of multidisciplinary treatment strategies with the immunological,coagulation,and tumor biomarker responses after post-TACE in HCC.METHODS This retrospective analysis included 100 patients with HCC who were categorized based on the treatment approach into the control(patients treated with TACE alone)and experimental groups(patients receiving multidisciplinary treatment strategies post-TACE).Participant characteristics,short-term efficacy,and safety assessment as well as immunological,coagulation,and tumor biomarker res-ponses between the two groups were collected and compared.RESULTS Compared with the control group,the experimental group demonstrated a superior overall response rate,along with an increased fibrinogen,markedly improved immunological biomarker,lower prothrombin time,thrombin time,alpha-fetoprotein,carcinoembryonic antigen,and carbohydrate antigen 199 levels,as well as a decreased abnormal prothrombin incidence,and a lower overall rate of adverse reactions.Notably,no significant difference in the activated partial thromboplastin time and D-dimer levels was observed between the two groups.CONCLUSION Multidisciplinary treatment strategies post-TACE have improved the treatment outcome,the immunological response,and the coagulation function,lowered the tumor biomarker response levels,and reduced the risk of adverse reactions in patients with HCC.
基金Supported by the Peking Union Medical College Hospital Central High-Level Hospital Clinical Research Project,No.2022-PUMCH-B-069。
文摘BACKGROUND Hepatic hemangiomas represent the most prevalent benign liver tumors.Surgical management of large symptomatic hepatic hemangiomas remains controversial and there is an increasing interest in minimally invasive techniques,such as transcatheter arterial chemoembolization(TACE)and microwave ablation(MWA).AIM To evaluate the efficacy and safety of TACE combined with MWA for large hepatic hemangiomas.METHODS This retrospective cohort study was conducted at Peking Union Medical College Hospital between January 2015 and January 2024.Eighty-two patients with hepatic hemangiomas>5 cm were divided into two groups:Observation(TACE+MWA,n=50)and control(TACE,n=32).Tumor diameter and treatment outcomes were evaluated at baseline,12 months,and>3 years.Appropriate statistical tests were chosen based on the type and distribution of the data.RESULTS At baseline,the median tumor diameter was 8.3(range:5.0-19.2)cm in the observation group and 8.5(range:5.0-20.0)cm in the control group.The median follow up duration was 44.6(95%confidence interval:36.7-52.5)months.At 12 months post-treatment,the observation group demonstrated a higher tumor reduction ratio compared to the control group(50.98%vs 23.28%,respectively;P<0.001).The objective response rate was 93.94%in the observation group,which was significantly higher than that in the control group(33.33%)(P<0.001).No recurrence occurred in the observation group,while one case occurred in the control group.Notably,no cases of hemoglobinuria or acute kidney injury were reported in the observation group.CONCLUSION Combination treatment enhances tumor shrinkage,promotes long-term tumor control,and reduces the complications associated with MWA,thereby presenting a promising alternative to surgical resection.
基金Supported by the National Natural Science Foundation of China,No.82404058Shanghai Municipal Commission of Health and Family Planning,No.2024ZZ2049Beijing Xisike Clinical Oncology Research Foundation,No.Y-HS202401-0011.
文摘In this article we commented on an article published recently by Jiao et al.This retrospective study confirmed that the triple therapy of transarterial chemoembolization(TACE)combined with programmed death protein ligand 1 inhibitors and molecular targeted therapy can significantly reverse TACE resistance in advanced hepatocellular carcinoma.Compared with TACE alone,the triple therapy reduced the resistance rate from 38.8%to 9.7%and increased the median progression-free survival and median overall survival by 92.3%and 26.8%,respectively.TACE induces tumor antigen release and upregulates programmed death protein ligand 1,activating the effect of immune checkpoint inhibitors while molecular targeted therapy inhibits postembolization vascular regeneration,forming a dynamic synergistic network of embolization-immune activation-vascular inhibition.The maximum tumor diameter,capsule loss,and bilateral distribution were identified as independent predictors.This study provided level I evidence and promoted the transformation of advanced hepatocellular carcinoma treatment from single local intervention to an integrated model of local control-systemic treatment.In the future it will be necessary to analyze the dynamic evolution rules of the tumor microenvironment through crossomics strategies,further explore biomarkers,optimize treatment sequences,and conduct multicenter prospective trials to verify long-term survival benefits and guide the optimization of individualized sequential treatment.
基金Supported by International Centre for Genetic Engineering and BiotechnologyHarry Crossley Foundation at the University of Cape Town.
文摘BACKGROUND Sub-Saharan Africa(SSA)and Southeast Asia account for 80%of hepatocellular carcinoma(HCC)cases globally.Public healthcare systems in low-and middleincome countries often face significant economic constraints,resulting in limited treatment options.The objectives of this study were to identify factors associated with poor outcomes in patients with Barcelona Clinic Liver Cancer(BCLC)stage C and D undergoing transarterial chemoembolization(TACE)and to compare their outcomes to patients treated tyrosine kinase inhibitors(TKIs)or best supportive care(BSC)only.AIM To assess clinical outcomes and identify predictive factors that may facilitate the broader implementation of TACE in patients with advanced HCC within resource-constrained settings such as SSA.METHODS A single-center,retrospective cohort study was conducted to investigate the risk factors associated with the outcome of TACE in patients with BCLC stage C and D using univariate and multivariate regression analysis.Frequency matching was used to ensure comparable distributions of confounding factors across patients treated with TACE,TKIs,or BSC.Survival analysis was performed to compare outcomes among the matched groups.RESULTS Patients with BCLC stage C and D presenting with elevated gamma-glutamyl transferase levels or elevated aspartate aminotransferase levels or portal vein infiltration were identified as high-risk and demonstrated poor response to TACE treatment.In contrast,patients with BCLC stage C disease who lacked these highrisk features showed significantly longer overall survival when treated with TACE compared to those who received BSC or TKIs.CONCLUSION Gamma-glutamyl transferase levels,aspartate aminotransferase levels,and portal vein infiltration are critical risk factors to consider when determining treatment strategies for HCC patients in SSA.Patients without these factors can derive significant benefits from TACE as an alternative to BSC or TKIs.
