Purpose: To provide a new approach for patients with hypovascular hepatocellular carcinoma in Barcelona clinic liver cancer (BCLC) stage A or B, and evaluate the safety, clinical outcomes of drug-eluting beads transarterial chemoembolization (D-TACE) and conventional TACE (C-TACE).
Material and Methods: The medical record based on the patients with hepatocellular carcinoma underwent TACE from January 2016 to June 2019 were reviewed in this study. The diagnosis of hypovascular hepatic carcinoma was conducted by two radiologists according to the imaging criteria. We assessed the adverse events (AEs), tumor response, and survival in the study. Clinical outcomes of patients between the D-TACE group and C-TACE group were analyzed by applying Kaplan-Meier methods.
Results: 98 patients with hypovascular hepatocellular carcinoma were included in the study. 46 patients underwent D-TACE treatment and 52 patients underwent C-TACE treatment. There was a better progression-free survival benefit (median PFS, 12.0 months vs 7.0 months, P < 0.001) and significant survival benefit (median OS, 21.0 months vs 14.0 months, P = 0.035) in these patients who underwent D-TACE treatment in the study. In addition, D-TACE treatment had better objective response rate (ORR, 76% vs 38%, P < 0.001) and disease control rate (DCR, 91% vs 75%, P = 0.033) compared to C-TACE treatment. The occurrence rate of AEs showed no difference between the two groups (67.3% vs 57.7%, P = 0.323). Surprisingly, we found that the treatment method can be identified as an independent prognostic factor of progression-free survival and overall survival.
Conclusions: For patients with hypovascular hepatocellular carcinoma in BCLC stage A or B, D-TACE as an effective treatment to yield better ORR and DCR, prolong PFS and OS, hence should be recommended to a wide range of clinical practice.