This article discusses the innovative use of computed tomography radiomics combined with clinical factors to predict treatment response to first-line transarterial chemoembolization in hepatocellular carcinoma.Zhao et...This article discusses the innovative use of computed tomography radiomics combined with clinical factors to predict treatment response to first-line transarterial chemoembolization in hepatocellular carcinoma.Zhao et al developed a robust predictive model demonstrating high accuracy(area under the curve 0.92 in the training cohort)by integrating venous phase radiomic features with alphafetoprotein levels.This noninvasive approach enables early identification of patients unlikely to benefit from transarterial chemoembolization,allowing a timely transition to alternative therapies such as targeted agents or immunotherapy.Such precision strategies may improve clinical outcomes,optimize resource utilization,and increase survival in advanced hepatocellular carcinoma management.Future studies should emphasize external validation and broader clinical adoption.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 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
Transcatheter arterial chemoembolization(TACE) is an effective palliative intervention that is widely accepted for the management of hepatocellular carcinoma(HCC). Post-TACE pulmonary complications resulting in acute ...Transcatheter arterial chemoembolization(TACE) is an effective palliative intervention that is widely accepted for the management of hepatocellular carcinoma(HCC). Post-TACE pulmonary complications resulting in acute lung injury(ALI) or acute respiratory distress syndrome(ARDS) are rare events. Pulmonary complications after TACE are thought to be related to chemical injury subsequent to the migration of the infused ethiodized oil or chemotherapeutic agent to the lung vasculature, facilitated by arteriovenous(AV) shunts within the hyper-vascular HCC. We review herein the literature on pulmonary complications related to TACE for HCC. Post-TACE pulmonary complications have included pulmonary oil embolism, interstitial pneumonitis, chemical pneumonitis, ALI, ARDS, lipoid pneumonia, acute eosinophilic and neutrophilic pneumonia, bilious pleuritis, pulmonary abscess, pulmonary tumor embolism, and possibly pulmonary metastasis with HCC. The risk factors associated with post-TACE pulmonary complications identified in the literature include large hyper-vascular HCC with AV shunts, large-volume Lipiodol infusion, and embolization via the right inferior phrenic artery. However, the absence of known risk factors is not a guarantee against serious complications. An astute awareness of the potential post-TACE pulmonary complications should expedite appropriate therapeutic interventions and increase potential for early recovery.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide.Transarterial chemoembolization(TACE)combined with percutaneous radiofrequency ablation(RFA)has emerged as a promising t...BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide.Transarterial chemoembolization(TACE)combined with percutaneous radiofrequency ablation(RFA)has emerged as a promising treatment strategy for patients with unresectable HCC.AIM To evaluate the effectiveness and safety of TACE combined with RFA compared to TACE alone in the management of primary HCC.METHODS A comprehensive retrospective analysis was conducted at our institution from January 2020 to January 2024,involving 106 patients diagnosed with intermediate to advanced-stage HCC.Patients were divided into two groups:Those receiving TACE alone(n=56)and those undergoing combined TACE and RFA therapy(n=50).Treatment efficacy was assessed based on tumor response rates,serum alphafetoprotein(AFP)levels,and survival outcomes.Statistical analyses,includingχ^(2)tests and Kaplan-Meier survival analysis,were performed to compare the outcomes between the two groups.RESULTS The TACE+RFA group demonstrated significantly higher rates of complete response(15 vs 4,P<0.01)and partial response(23 vs 15,P=0.046)compared to the TACE group.Conversely,the TACE group exhibited higher rates of stable disease(25 vs 7,P<0.01)and progressive disease(12 vs 5,P<0.01).Serum AFP levels decreased over time in the TACE+RFA group,while they increased in the TACE group.Survival analysis revealed superior survival outcomes in the TACE+RFA group,with higher survival rates and a prolonged median survival time compared to the TACE group.CONCLUSION The combination of RFA with TACE could offer enhanced treatment response and prolonged survival in patients with primary HCC compared to TACE alone.These findings might support the adoption of multimodal therapeutic approaches,emphasizing the importance of personalized treatment strategies in the management of HCC.展开更多
Transcatheter arterial chemoembolization(TACE) is widely accepted as a treatment for patients with hepatocellular carcinoma(HCC) in the intermediate stage according to the Barcelona Clinic Liver Cancer(BCLC) guideline...Transcatheter arterial chemoembolization(TACE) is widely accepted as a treatment for patients with hepatocellular carcinoma(HCC) in the intermediate stage according to the Barcelona Clinic Liver Cancer(BCLC) guidelines. Recently, balloon-occluded TACE(B-TACE) was developed in Japan. Despite the lack of a clear definition, B-TACE is generally defined as the infusion of emulsion of chemotherapeutic agents with lipiodol followed by gelatin particles under the occlusion of feeding arteries by a microballoon catheter, which leads to the dense lipiodol emulsion(LE) accumulation in HCC nodules. This phenomenon cannot be explained only by the prevention of proximal migration and leakage of embolization materials; it further involves causing local changes in the hemodynamics of the surrounding occlusion artery and targeted HCC nodules. Balloon-occluded arterial stump pressure plays an important role in the dense LE accumulation in targeted HCC nodules. Although randomized controlled trials comparing the therapeutic effect and the prognosis of B-TACE to those of the other TACE procedures, such as conventional-TACE and drug-eluting beads TACE, are still lacking, B-TACE is thought to be a promising treatment. The purpose of this review is to summarize the mechanism, therapeutic effect, indication, prognosis and complications of BTACE.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
Objective: To investigate the effects of bronchial arterial chemoembolization combined with radioactive particle implantation on the level of serum tumor markers and T lymphocyte subsets in patients with locally advan...Objective: To investigate the effects of bronchial arterial chemoembolization combined with radioactive particle implantation on the level of serum tumor markers and T lymphocyte subsets in patients with locally advanced non-small cell lung cancer. Methods: A total of 91 cases of locally advanced non-small cell lung cancer patients according to the random data table were divided into the control group (n=45) and observation group (n=46) according to the random data table. Patients in the control group was treated with bronchial arterial chemoembolization, on the basis of the control group, patients in the observation group were treated with radioactive particle implantation, the serum tumor markers and T lymphocyte subsets of the two groups were compared before and after treatment. Results: The levels of CEA, NSE, CA125, CD4+, CD8+, CD4+/CD8+ and NK in the two groups before the treatment were not statistically significant. Compared with the group before treatment, levels of CEA, NSE, CA125and CD8+ of the two groups after treatment were significantly decreased, and after treatment the level of CEA, NSE, CA125and CD8+ in the observation group was significantly lower than those of the control group;The levels of CD4+, CD4+/CD8+ and NK in the two groups after treatment were significantly higher than those in the group before treatment, and the observation group levels were significantly higher than those of the control group. Conclusion: Bronchial artery embolization combined with radioactive particle implantation for locally advanced non-small cell lung cancer, can effectively reduce the serum tumor markers level, improve the level of T cell subsets of patients, has important clinical value.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
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
BACKGROUND Acute cholecystitis due to unintended cystic artery embolism is an uncommon and mostly self-limiting complication after transarterial chemoembolization procedure for treatment of hepatocellular carcinoma.Us...BACKGROUND Acute cholecystitis due to unintended cystic artery embolism is an uncommon and mostly self-limiting complication after transarterial chemoembolization procedure for treatment of hepatocellular carcinoma.Usually,conservative management is sufficient for complete recovery of patients who develop this complication.If conservative treatment is ineffective,urgent surgical inter-vention may be required to prevent the progression of complications.CASE SUMMARY This article reports a rare and serious case of acute cholecystitis complicated by gallbladder necrosis and biliary peritonitis,which was initially treated conservatively but eventually necessitated emergency laparotomy.The patient initially presented with equivocal symptoms of fever and upper abdominal pain and distention,which worsened at the two weeks mark along with emergence of signs of peritonitis.This was managed by emergency laparotomy and cholecystostomy,allowing rapid symptom relief.The patient ultimately discharged and succumbed to advanced liver cancer 11 months after diagnosis.CONCLUSION After cholecystostomy,the patient showed symptom relief and was discharged,surviving 11 months post-stage IIIB liver cancer diagnosis.展开更多
BACKGROUND Primary liver cancer,predominantly hepatocellular carcinoma(HCC),is a major cause of cancer-related mortality.Transarterial chemoembolization(TACE)is a key palliative option for unresectable HCC.However,pro...BACKGROUND Primary liver cancer,predominantly hepatocellular carcinoma(HCC),is a major cause of cancer-related mortality.Transarterial chemoembolization(TACE)is a key palliative option for unresectable HCC.However,prognostic outcomes after TACE vary significantly.This study evaluated the prognostic value of the fibrinogen and neutrophil-to-lymphocyte ratio(F-NLR)score,serum alpha-fetoprotein(AFP),and prealbumin(PA)in patients undergoing TACE.AIM To investigate the prognostic significance of F-NLR score,AFP,and PA in patients undergoing TACE.METHODS Variables such as F-NLR score,AFP,PA,and other clinical indicators were assessed.Follow-ups determined prognosis as good or poor.Statistical asse-ssments,including receiver operating characteristic analyses,were performed to evaluate the prognostic significance and develop an integrated predictive model.RESULTS A retrospective analysis of 162 patients with primary liver cancer undergoing TACE was conducted.Low F-NLR scores and AFP levels and high PA were significantly associated with a good prognosis.The combined model,which integrated F-NLR,AFP,and PA,demonstrated a favorable prognostic predictive capability,with an area under the curve of 0.933.CONCLUSION Preoperative F-NLR,AFP,and PA are valuable prognostic predictors in patients with HCC undergoing TACE.展开更多
Background:Transarterial chemoembolization(TACE)based neoadjuvant therapy was proven effective in hepatocellular carcinoma(HCC).Recently,tyrosine kinase inhibitors(TKIs)and immune checkpoint inhibitors(ICIs)also showe...Background:Transarterial chemoembolization(TACE)based neoadjuvant therapy was proven effective in hepatocellular carcinoma(HCC).Recently,tyrosine kinase inhibitors(TKIs)and immune checkpoint inhibitors(ICIs)also showed promise in HCC treatment.However,the prognostic benefits associated with these treatments remain uncertain.This study aimed to explore the relationship between pathologic response and prognostic features in HCC patients who received neoadjuvant therapy.Methods:HCC patients who received TACE either with or without TKIs/ICIs as neoadjuvant therapy before liver resection were retrospectively collected from the First Affiliated Hospital,Zhejiang University School of Medicine in China.Pathologic response was determined by calculating the proportion of non-viable area within the tumor.Major pathologic response(MPR)was defined as the presence of non-viable tumor cells reaching a minimum of 90%.Complete pathologic response(CPR)was characterized by the absence of viable cells observed in the tumor.Results:A total of 481 patients meeting the inclusion criteria were enrolled,with 76 patients(15.8%)achieving CPR and 179(37.2%)reaching MPR.The median recurrence-free survival(m RFS)in the CPR+MPR group was significantly higher than the non-MPR group(31.3 vs.25.1 months).The difference in 3-year overall survival(OS)rate was not significant.Multivariate Cox regression analysis identified failure to achieve MPR(hazard ratio=1.548,95%confidence interval:1.122–2.134;P=0.008),HBs Ag positivity(HR=1.818,95%CI:1.062–3.115,P=0.030),multiple lesions(HR=2.278,95%CI:1.621–3.195,P<0.001),and baseline tumor size>5 cm(HR=1.712,95%CI:1.031–2.849,P=0.038)were independent risk factors for RFS.Subgroup analysis showed that 67 of 93(72.0%)patients who received the combination of TACE,TKIs,and ICIs achieved MPR+CPR.Conclusions:In individuals who received TACE-based neoadjuvant therapy for HCC,failure to achieve MPR emerges as an independent risk factor for RFS.Notably,the combination of TACE,TKIs,and ICIs demonstrated the highest rate of MPR.展开更多
BACKGROUND Hepatocellular carcinoma with portal vein tumor thrombus(HCC-PVTT)is a severe condition with poor prognosis.While transarterial chemoembolization(TACE)combined with lenvatinib(TACE-L)shows some promise,surv...BACKGROUND Hepatocellular carcinoma with portal vein tumor thrombus(HCC-PVTT)is a severe condition with poor prognosis.While transarterial chemoembolization(TACE)combined with lenvatinib(TACE-L)shows some promise,survival outcomes remain suboptimal.We hypothesize that TACE-L plus programmed cell death protein-1 inhibitors(TACE-L-P)may offer superior survival benefits compared to TACE-L in this patient population.AIM To compare efficacy and safety of TACE-L-P vs TACE-L in HCC-PVTT and identify prognostic factors.METHODS Data from HCC-PVTT patients treated with TACE-L-P or TTACE-L from January 2018 to December 2023 were collected and retrospectively analyzed.Propensity score matching(PSM)method with optimal matching was used to minimize confounding bias.Overall survival(OS),progression-free survival(PFS),objective response rate(ORR),and treatment-related adverse events(AEs)were compared between the two groups.Independent prognostic factors for OS and PFS were elucidated using the Cox proportional hazards model.RESULTS A total of 100 patients were included,with 42 patients in the TACE-L-P group and 68 patients in the TACE-L group.After PSM performing optimal matching,baseline characteristics were well balanced between the two groups,each comprising 42 patients.The median OS was significantly longer in the TACE-L-P group compared to the TACE-L group(17.2 months vs 12.6 months,P=0.0207),as was the median PFS(10.6 months vs 7.1 months,P=0.012).The ORR and disease control rate were both superior in the TACE-L-P group compared to the TACE-L group(66.7%vs 42.9%,P=0.049;78.6%vs 50.0%,P=0.012).Multivariate analysis revealed that the independent prognostic factors for both OS and PFS were the treatment regimen and extrahepatic metastasis.The incidence of any-grade and grade 3 AEs was comparable between the TACE-L-P and TACE-L groups(84.5%vs 88.1%,P=0.546),with no occurrences of grade 4/5 AEs or treatment-related mortality in either group.CONCLUSION Compared to TACE-L,the TACE-L-P regimen exhibits an acceptable safety profile and shows potential in improving survival outcomes,making it a promising therapeutic option for patients with HCC-PVTT.展开更多
AIM:To assess the possible effect of two different types of preoperative transcatheter arterial chemoembolization(TACE)on recurrence-free survival after liver transplantation(LT)in patients with hepatocellular carcino...AIM:To assess the possible effect of two different types of preoperative transcatheter arterial chemoembolization(TACE)on recurrence-free survival after liver transplantation(LT)in patients with hepatocellular carcinoma(HCC)and to analyze the effects of TACE on tumor histology.METHODS:We retrospectively analyzed the histological features of 130 HCC nodules in 63 native livers removed at transplantation.Patients who received any other type of treatment such as radiofrequency tumor ablation,percutaneous ethanol ablation or who were not treated at all were excluded.All patients in the present study were within the Milan Criteria at the last imaging findings before transplantation.Doxorubicineluting bead TACE(DEB-TACE)was performed in 22patients(38 nodules),and conventional TACE(c-TACE)in 16(25 nodules).Patients’and tumors’characteristics were retrospectively reviewed.We performed a pernodule analysis of the explanted livers to establish the mean percentage of necrosis of any nodule treated by TACE(conventional or DEB)and a per-patient analysis to establish the percentage of necrosis in the cumulative tumor area,including 21 nodules not reached by TACE.Inflammatory and fibrotic changes in the tissue surrounding the tumor nodule were analyzed and categorized as poor/absent,moderate and enhanced reaction.Uni-and multivariate analysis of risk factors for HCC-recurrence were performed.RESULTS:The number and diameter of the nodules,the time spent on the waiting list and the number of treatments were similar in the two groups.A trend towards higher appropriate response rates(necrosis≥90%)was observed in the DEB-TACE group(44.7%vs32.0%,P=0.2834).The mean percentage of necrosis in the cumulative tumor area was 58.8%±36.6%in the DEB-TACE group and 50.2%±38.1%in the c-TACE group(P=0.4856).Fibrotic and inflammatory reactions surrounding the tumor nodule were markedly more common in the DEB-TACE group(P<0.0001,for both the parameters).The three-year recurrence-free survival was higher in DEB-TACE-treated patients than in conventionally treated patients(87.4%vs 61.5%,P=0.0493).Other factors affecting recurrence-free survival included viable tumor beyond Milan Criteria on histopathological examination,the percentage of necrosis on CTA≤50%and a pre-transplant serum-fetoprotein level greater than 70 ng/mL.On multivariate analysis,the lack of treatment with DEB-TACE,high levels of-fetoprotein and viable tumor beyond Milan Criteria at histology examination were identified as independent predictors of tumor recurrence.CONCLUSION:DEB-TACE can effectively promote tumor necrosis and improves recurrence-free survival after LT in HCC.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 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 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
文摘This article discusses the innovative use of computed tomography radiomics combined with clinical factors to predict treatment response to first-line transarterial chemoembolization in hepatocellular carcinoma.Zhao et al developed a robust predictive model demonstrating high accuracy(area under the curve 0.92 in the training cohort)by integrating venous phase radiomic features with alphafetoprotein levels.This noninvasive approach enables early identification of patients unlikely to benefit from transarterial chemoembolization,allowing a timely transition to alternative therapies such as targeted agents or immunotherapy.Such precision strategies may improve clinical outcomes,optimize resource utilization,and increase survival in advanced hepatocellular carcinoma management.Future studies should emphasize external validation and broader clinical adoption.
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.
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Transcatheter arterial chemoembolization(TACE) is an effective palliative intervention that is widely accepted for the management of hepatocellular carcinoma(HCC). Post-TACE pulmonary complications resulting in acute lung injury(ALI) or acute respiratory distress syndrome(ARDS) are rare events. Pulmonary complications after TACE are thought to be related to chemical injury subsequent to the migration of the infused ethiodized oil or chemotherapeutic agent to the lung vasculature, facilitated by arteriovenous(AV) shunts within the hyper-vascular HCC. We review herein the literature on pulmonary complications related to TACE for HCC. Post-TACE pulmonary complications have included pulmonary oil embolism, interstitial pneumonitis, chemical pneumonitis, ALI, ARDS, lipoid pneumonia, acute eosinophilic and neutrophilic pneumonia, bilious pleuritis, pulmonary abscess, pulmonary tumor embolism, and possibly pulmonary metastasis with HCC. The risk factors associated with post-TACE pulmonary complications identified in the literature include large hyper-vascular HCC with AV shunts, large-volume Lipiodol infusion, and embolization via the right inferior phrenic artery. However, the absence of known risk factors is not a guarantee against serious complications. An astute awareness of the potential post-TACE pulmonary complications should expedite appropriate therapeutic interventions and increase potential for early recovery.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide.Transarterial chemoembolization(TACE)combined with percutaneous radiofrequency ablation(RFA)has emerged as a promising treatment strategy for patients with unresectable HCC.AIM To evaluate the effectiveness and safety of TACE combined with RFA compared to TACE alone in the management of primary HCC.METHODS A comprehensive retrospective analysis was conducted at our institution from January 2020 to January 2024,involving 106 patients diagnosed with intermediate to advanced-stage HCC.Patients were divided into two groups:Those receiving TACE alone(n=56)and those undergoing combined TACE and RFA therapy(n=50).Treatment efficacy was assessed based on tumor response rates,serum alphafetoprotein(AFP)levels,and survival outcomes.Statistical analyses,includingχ^(2)tests and Kaplan-Meier survival analysis,were performed to compare the outcomes between the two groups.RESULTS The TACE+RFA group demonstrated significantly higher rates of complete response(15 vs 4,P<0.01)and partial response(23 vs 15,P=0.046)compared to the TACE group.Conversely,the TACE group exhibited higher rates of stable disease(25 vs 7,P<0.01)and progressive disease(12 vs 5,P<0.01).Serum AFP levels decreased over time in the TACE+RFA group,while they increased in the TACE group.Survival analysis revealed superior survival outcomes in the TACE+RFA group,with higher survival rates and a prolonged median survival time compared to the TACE group.CONCLUSION The combination of RFA with TACE could offer enhanced treatment response and prolonged survival in patients with primary HCC compared to TACE alone.These findings might support the adoption of multimodal therapeutic approaches,emphasizing the importance of personalized treatment strategies in the management of HCC.
文摘Transcatheter arterial chemoembolization(TACE) is widely accepted as a treatment for patients with hepatocellular carcinoma(HCC) in the intermediate stage according to the Barcelona Clinic Liver Cancer(BCLC) guidelines. Recently, balloon-occluded TACE(B-TACE) was developed in Japan. Despite the lack of a clear definition, B-TACE is generally defined as the infusion of emulsion of chemotherapeutic agents with lipiodol followed by gelatin particles under the occlusion of feeding arteries by a microballoon catheter, which leads to the dense lipiodol emulsion(LE) accumulation in HCC nodules. This phenomenon cannot be explained only by the prevention of proximal migration and leakage of embolization materials; it further involves causing local changes in the hemodynamics of the surrounding occlusion artery and targeted HCC nodules. Balloon-occluded arterial stump pressure plays an important role in the dense LE accumulation in targeted HCC nodules. Although randomized controlled trials comparing the therapeutic effect and the prognosis of B-TACE to those of the other TACE procedures, such as conventional-TACE and drug-eluting beads TACE, are still lacking, B-TACE is thought to be a promising treatment. The purpose of this review is to summarize the mechanism, therapeutic effect, indication, prognosis and complications of BTACE.
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.
基金the National Natural Science Foundation of China(81541061).
文摘Objective: To investigate the effects of bronchial arterial chemoembolization combined with radioactive particle implantation on the level of serum tumor markers and T lymphocyte subsets in patients with locally advanced non-small cell lung cancer. Methods: A total of 91 cases of locally advanced non-small cell lung cancer patients according to the random data table were divided into the control group (n=45) and observation group (n=46) according to the random data table. Patients in the control group was treated with bronchial arterial chemoembolization, on the basis of the control group, patients in the observation group were treated with radioactive particle implantation, the serum tumor markers and T lymphocyte subsets of the two groups were compared before and after treatment. Results: The levels of CEA, NSE, CA125, CD4+, CD8+, CD4+/CD8+ and NK in the two groups before the treatment were not statistically significant. Compared with the group before treatment, levels of CEA, NSE, CA125and CD8+ of the two groups after treatment were significantly decreased, and after treatment the level of CEA, NSE, CA125and CD8+ in the observation group was significantly lower than those of the control group;The levels of CD4+, CD4+/CD8+ and NK in the two groups after treatment were significantly higher than those in the group before treatment, and the observation group levels were significantly higher than those of the control group. Conclusion: Bronchial artery embolization combined with radioactive particle implantation for locally advanced non-small cell lung cancer, can effectively reduce the serum tumor markers level, improve the level of T cell subsets of patients, has important clinical value.
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 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National Natural Science Foundation of China,No.82200686Shaanxi Provincial People's Hospital Incubation Project,No.2022YJY-14.
文摘BACKGROUND Acute cholecystitis due to unintended cystic artery embolism is an uncommon and mostly self-limiting complication after transarterial chemoembolization procedure for treatment of hepatocellular carcinoma.Usually,conservative management is sufficient for complete recovery of patients who develop this complication.If conservative treatment is ineffective,urgent surgical inter-vention may be required to prevent the progression of complications.CASE SUMMARY This article reports a rare and serious case of acute cholecystitis complicated by gallbladder necrosis and biliary peritonitis,which was initially treated conservatively but eventually necessitated emergency laparotomy.The patient initially presented with equivocal symptoms of fever and upper abdominal pain and distention,which worsened at the two weeks mark along with emergence of signs of peritonitis.This was managed by emergency laparotomy and cholecystostomy,allowing rapid symptom relief.The patient ultimately discharged and succumbed to advanced liver cancer 11 months after diagnosis.CONCLUSION After cholecystostomy,the patient showed symptom relief and was discharged,surviving 11 months post-stage IIIB liver cancer diagnosis.
基金Supported by Health Commission of Heilongjiang Province,No.0230404080031.
文摘BACKGROUND Primary liver cancer,predominantly hepatocellular carcinoma(HCC),is a major cause of cancer-related mortality.Transarterial chemoembolization(TACE)is a key palliative option for unresectable HCC.However,prognostic outcomes after TACE vary significantly.This study evaluated the prognostic value of the fibrinogen and neutrophil-to-lymphocyte ratio(F-NLR)score,serum alpha-fetoprotein(AFP),and prealbumin(PA)in patients undergoing TACE.AIM To investigate the prognostic significance of F-NLR score,AFP,and PA in patients undergoing TACE.METHODS Variables such as F-NLR score,AFP,PA,and other clinical indicators were assessed.Follow-ups determined prognosis as good or poor.Statistical asse-ssments,including receiver operating characteristic analyses,were performed to evaluate the prognostic significance and develop an integrated predictive model.RESULTS A retrospective analysis of 162 patients with primary liver cancer undergoing TACE was conducted.Low F-NLR scores and AFP levels and high PA were significantly associated with a good prognosis.The combined model,which integrated F-NLR,AFP,and PA,demonstrated a favorable prognostic predictive capability,with an area under the curve of 0.933.CONCLUSION Preoperative F-NLR,AFP,and PA are valuable prognostic predictors in patients with HCC undergoing TACE.
基金supported by grants from the National Natural Science Foundation of China(82270682)the Natural Science Foundation of Zhejiang Province(LQ21H030007 and LQ20H30006)。
文摘Background:Transarterial chemoembolization(TACE)based neoadjuvant therapy was proven effective in hepatocellular carcinoma(HCC).Recently,tyrosine kinase inhibitors(TKIs)and immune checkpoint inhibitors(ICIs)also showed promise in HCC treatment.However,the prognostic benefits associated with these treatments remain uncertain.This study aimed to explore the relationship between pathologic response and prognostic features in HCC patients who received neoadjuvant therapy.Methods:HCC patients who received TACE either with or without TKIs/ICIs as neoadjuvant therapy before liver resection were retrospectively collected from the First Affiliated Hospital,Zhejiang University School of Medicine in China.Pathologic response was determined by calculating the proportion of non-viable area within the tumor.Major pathologic response(MPR)was defined as the presence of non-viable tumor cells reaching a minimum of 90%.Complete pathologic response(CPR)was characterized by the absence of viable cells observed in the tumor.Results:A total of 481 patients meeting the inclusion criteria were enrolled,with 76 patients(15.8%)achieving CPR and 179(37.2%)reaching MPR.The median recurrence-free survival(m RFS)in the CPR+MPR group was significantly higher than the non-MPR group(31.3 vs.25.1 months).The difference in 3-year overall survival(OS)rate was not significant.Multivariate Cox regression analysis identified failure to achieve MPR(hazard ratio=1.548,95%confidence interval:1.122–2.134;P=0.008),HBs Ag positivity(HR=1.818,95%CI:1.062–3.115,P=0.030),multiple lesions(HR=2.278,95%CI:1.621–3.195,P<0.001),and baseline tumor size>5 cm(HR=1.712,95%CI:1.031–2.849,P=0.038)were independent risk factors for RFS.Subgroup analysis showed that 67 of 93(72.0%)patients who received the combination of TACE,TKIs,and ICIs achieved MPR+CPR.Conclusions:In individuals who received TACE-based neoadjuvant therapy for HCC,failure to achieve MPR emerges as an independent risk factor for RFS.Notably,the combination of TACE,TKIs,and ICIs demonstrated the highest rate of MPR.
基金Supported by Zhejiang Province Medicine and Health Science and Technology Project,No.2023KY239Zhejiang Province Traditional Chinese Medicine Science and Technology Plan Project,No.2024ZL949.
文摘BACKGROUND Hepatocellular carcinoma with portal vein tumor thrombus(HCC-PVTT)is a severe condition with poor prognosis.While transarterial chemoembolization(TACE)combined with lenvatinib(TACE-L)shows some promise,survival outcomes remain suboptimal.We hypothesize that TACE-L plus programmed cell death protein-1 inhibitors(TACE-L-P)may offer superior survival benefits compared to TACE-L in this patient population.AIM To compare efficacy and safety of TACE-L-P vs TACE-L in HCC-PVTT and identify prognostic factors.METHODS Data from HCC-PVTT patients treated with TACE-L-P or TTACE-L from January 2018 to December 2023 were collected and retrospectively analyzed.Propensity score matching(PSM)method with optimal matching was used to minimize confounding bias.Overall survival(OS),progression-free survival(PFS),objective response rate(ORR),and treatment-related adverse events(AEs)were compared between the two groups.Independent prognostic factors for OS and PFS were elucidated using the Cox proportional hazards model.RESULTS A total of 100 patients were included,with 42 patients in the TACE-L-P group and 68 patients in the TACE-L group.After PSM performing optimal matching,baseline characteristics were well balanced between the two groups,each comprising 42 patients.The median OS was significantly longer in the TACE-L-P group compared to the TACE-L group(17.2 months vs 12.6 months,P=0.0207),as was the median PFS(10.6 months vs 7.1 months,P=0.012).The ORR and disease control rate were both superior in the TACE-L-P group compared to the TACE-L group(66.7%vs 42.9%,P=0.049;78.6%vs 50.0%,P=0.012).Multivariate analysis revealed that the independent prognostic factors for both OS and PFS were the treatment regimen and extrahepatic metastasis.The incidence of any-grade and grade 3 AEs was comparable between the TACE-L-P and TACE-L groups(84.5%vs 88.1%,P=0.546),with no occurrences of grade 4/5 AEs or treatment-related mortality in either group.CONCLUSION Compared to TACE-L,the TACE-L-P regimen exhibits an acceptable safety profile and shows potential in improving survival outcomes,making it a promising therapeutic option for patients with HCC-PVTT.
文摘AIM:To assess the possible effect of two different types of preoperative transcatheter arterial chemoembolization(TACE)on recurrence-free survival after liver transplantation(LT)in patients with hepatocellular carcinoma(HCC)and to analyze the effects of TACE on tumor histology.METHODS:We retrospectively analyzed the histological features of 130 HCC nodules in 63 native livers removed at transplantation.Patients who received any other type of treatment such as radiofrequency tumor ablation,percutaneous ethanol ablation or who were not treated at all were excluded.All patients in the present study were within the Milan Criteria at the last imaging findings before transplantation.Doxorubicineluting bead TACE(DEB-TACE)was performed in 22patients(38 nodules),and conventional TACE(c-TACE)in 16(25 nodules).Patients’and tumors’characteristics were retrospectively reviewed.We performed a pernodule analysis of the explanted livers to establish the mean percentage of necrosis of any nodule treated by TACE(conventional or DEB)and a per-patient analysis to establish the percentage of necrosis in the cumulative tumor area,including 21 nodules not reached by TACE.Inflammatory and fibrotic changes in the tissue surrounding the tumor nodule were analyzed and categorized as poor/absent,moderate and enhanced reaction.Uni-and multivariate analysis of risk factors for HCC-recurrence were performed.RESULTS:The number and diameter of the nodules,the time spent on the waiting list and the number of treatments were similar in the two groups.A trend towards higher appropriate response rates(necrosis≥90%)was observed in the DEB-TACE group(44.7%vs32.0%,P=0.2834).The mean percentage of necrosis in the cumulative tumor area was 58.8%±36.6%in the DEB-TACE group and 50.2%±38.1%in the c-TACE group(P=0.4856).Fibrotic and inflammatory reactions surrounding the tumor nodule were markedly more common in the DEB-TACE group(P<0.0001,for both the parameters).The three-year recurrence-free survival was higher in DEB-TACE-treated patients than in conventionally treated patients(87.4%vs 61.5%,P=0.0493).Other factors affecting recurrence-free survival included viable tumor beyond Milan Criteria on histopathological examination,the percentage of necrosis on CTA≤50%and a pre-transplant serum-fetoprotein level greater than 70 ng/mL.On multivariate analysis,the lack of treatment with DEB-TACE,high levels of-fetoprotein and viable tumor beyond Milan Criteria at histology examination were identified as independent predictors of tumor recurrence.CONCLUSION:DEB-TACE can effectively promote tumor necrosis and improves recurrence-free survival after LT in HCC.
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 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.
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.
