Patients’ characteristics
There were 15 unresectable liver cancer patients (including 12 (80.0%) males and 3 (20.0%) females) with the mean age of 48.9±14.2 years old (Table 1). For clinical features, the mean value of largest tumor diameter was 8.8±3.9 cm. The numbers of patients with ECOG score at 0, 1, and 2 were 2 (13.3%), 11 (73.4%) and 2 (13.3%) respectively. Based on BCLC stage, 8 (53.3%) patients were at A stage, 3 (20.0%) at B stage, and 4 (26.7) at C stage. According to Child-Pugh stage, 14 (93.3%) patients were at A stage, and 1 (6.7%) patient was at B stage. In addition, there were 10 (66.6%) patients received 1 cycle of DEB-TACE, 4 (26.7%) patients received 2 cycles of DEB-TACE, and 1 (6.7%) patients received 3 cycles of DEB-TACE. The detailed information about others clinical characteristics of patients were shown in Table 1.
Table 1
Clinical characteristics of patients
Items | Patients (N=15) |
Age (years), mean±SD | 48.9±14.2 |
Gender, No. (%) | |
Male | 12 (80.0) |
Female | 3 (20.0) |
History of drink, No. (%) | 5 (33.3) |
History of HB, No. (%) | 12 (80.0) |
History of hepatic encephalopathy, No. (%) | 2 (13.3) |
History of hypertension, No. (%) | 3 (20.0) |
History of heart disease, No. (%) | 1 (6.7) |
Liver cirrhosis, No. (%) | 9 (60.0) |
Histological type, No. (%) | |
HCC | 13 (86.7) |
Cholangiocarcinoma | 2 (13.3) |
Number of tumors, No. (%) | |
1 | 12 (80.0) |
2 | 3 (20.0) |
Largest tumor diameter (cm), mean±SD | 8.8±3.9 |
Portal vein invasion, No. (%) | 1 (6.7) |
Lymphadenectasis, No. (%) | 5 (33.3) |
Distant metastasis, No. (%) | 2 (13.3) |
Liver involvement, No. (%) | |
≤50% | 1 (6.7) |
50-70% | 10 (66.7) |
≥70% | 3 (20.0) |
Unknown | 1 (6.7) |
ECOG score, No. (%) | |
0 | 2 (13.3) |
1 | 11 (73.4) |
2 | 2 (13.3) |
BCLC stage, No. (%) | |
A | 8 (53.3) |
B | 3 (20.0) |
C | 4 (26.7) |
Child-Pugh stage, No. (%) | |
A | 14 (93.3) |
B | 1 (6.7) |
Cycles of DEB-TACE, No. (%) | |
1 | 10 (66.6) |
2 | 4 (26.7) |
3 | 1 (6.7) |
SD, standard deviation; HB, hepatitis B; HCC, hepatocellular carcinoma; ECOG, Eastern Cooperative Oncology Group; BCLC, Barcelona clinic liver cancer; DEB-TACE, drug-eluting bead transarterial chemoembolization. |
Treatment Response After Deb-tace
After DEB-TACE treatment at one month, in total patients, 3 (20.0%) patients achieved CR, 7 (46.7%) patients achieved PR and 10 (66.7%) patients achieved ORR (Figure 1A). As for PR patients, 2 (28.6%) patients presented with necrosis rate <50%, 4 (57.1%) patients presented with necrosis rate of 50-80%, and 1 (14.3%) patient presented with necrosis rate > 80% (Figure 1B). In total tumors, 5 (27.8%) tumors achieved CR, 7 (38.9%) tumors achieved PR and 12 (66.7%) tumors achieved ORR (Figure 1C). As for PR tumors, 2 (28.6%) tumors presented with necrosis rate <50%, 4 (57.1%) tumors presented with necrosis rate of 50-80%, and 1 (14.3%) tumors presented with necrosis rate > 80% (Figure 1D).
Comparison of tumor diameters, BCLC stage and Child-Pugh stage before and after DEB-TACE
For tumor diameters, it was decreased after DEB-TACE compared to before DEB-TACE (9.4±3.3 vs. 5.4±3.5 cm) (P<0.01) (Figure 2A). However, there was no difference in BCLC stage (P=0.317) (Figure 2B) and Child-Pugh stage (Figure 2C).
Comparison of the residual liver volume before and after DEB-TACE
The mean value of residual liver volume before and after DEB-TACE was 1066.2 cm3 and 1172.5 cm3 respectively (Table 2). Compared to before DEB-TACE, residual liver volume was increased after DEB-TACE (mean value of increased rate was 11.4%) (P=0.007). The detailed information about the residual liver volume in each patient before and after DEB-TACE was shown in Table 2.
Table 2
The residual liver volume before and after DEB-TACE
No. | Residual liver volume (cm3) | P value |
Before DEB-TACE | After DEB-TACE | Increase | Increase rate (%) |
1 | 1182.0 | 1064.0 | -118.0 | -10.0 | 0.007 |
2 | 1006.0 | 1083.0 | 77.0 | 7.7 |
3 | 1266.0 | 1407.0 | 141.0 | 11.1 |
4 | 1021.8 | 972.8 | -49.0 | -4.8 |
5 | 705.0 | 832.0 | 127.0 | 18.0 |
6 | 1514.0 | 1659.0 | 145.0 | 9.6 |
7 | 796.8 | 706.0 | -90.8 | -11.4 |
8 | 784.0 | 1169.0 | 385.0 | 49.1 |
9 | 1547.0 | 1740.0 | 193.0 | 12.5 |
10 | 1266.0 | 1358.0 | 92.0 | 7.3 |
11 | 1371.0 | 1371.0 | 0.0 | 0.0 |
12 | 1127.0 | 1347.0 | 220.0 | 19.5 |
13 | 944.0 | 1066.0 | 122.0 | 12.9 |
14 | 909.0 | 1100.0 | 191.0 | 21.0 |
15 | 554.0 | 713.0 | 159.0 | 28.7 |
Mean | 1066.2 | 1172.5 | 106.3 | 11.4 | |
Comparison was determined by Paired-sample t test. DEB-TACE, drug-eluting bead transarterial chemoembolization. |
Comparison Of Liver Function Indexes Before And After Deb-tace
No difference was found in liver function indexes, including ALB (P=0.334), TP (P=0.256), TBIL (P=0.733), TBA (P=0.513), ALT (P=0.609) and AST (P=0.593) and ALP (P=0.050) (Table 3). The detailed information was shown in Table 3.
Table 3
The level of liver function indexes before and after DEB-TACE
Liver function indexes | Before DEB-TACE | After DEB-TACE | P value |
ALB (g/L) | 42.4 (38.2-44.7) | 39.8 (37.0-42.3) | 0.334 |
TP (g/L) | 70.5 (63.2-76.0) | 72.0 (63.8-79.0) | 0.256 |
TBIL (µmol/L) | 8.7 (7.3-10.9) | 10.2 (7.0-13.0) | 0.733 |
TBA (µmol/L) | 7.3 (2.9-15.9) | 6.2 (3.4-13.9) | 0.513 |
ALT (U/L) | 50.0 (22.0-59.0) | 30.0 (24.0-46.0) | 0.609 |
AST (U/L) | 33.0 (26.0-59.0) | 30.0 (26.0-37.0) | 0.593 |
ALP (U/L) | 109.0 (91.0-130.0) | 120.0 (94.0-158.0) | 0.050 |
Data were displayed as median (interquartile range). Comparison was determined by Wilcoxon signed-rank test. DEB-TACE, drug-eluting bead transarterial chemoembolization; ALB, albumin; IQR, interquartile range; TP, total protein; TBIL, total bilirubin; TBA, total bile acid; ALT, alanine transaminase; AST, aspartate aminotransferase; ALP, alkaline phosphatase. |
Comparison Of Tumor Markers Before And After Deb-tace
For tumor markers, no difference was discovered in AFP (P=0.300) (Figure 3A), CEA (P=0.505) (Figure 3B) and CA191 (P=0.091) (Figure 3C).
Operation Types
In total patients, there were 14 (93.3%) patients received with curative resection, and 1 (6.7%) patient received palliative resection (Figure 4).
Rfs And Os
The median value of RFS was 26.0 months, and the percentage of 5-year accumulating RFS was 20% (Figure 5A). As to OS, the median value of OS was 54.5 months, and the percentage of 5-year accumulating OS was 40% (Figure 5B).
Adverse Events
After DEB-TACE, there were 5 patients presented with pain (NRS score ranging from 5 to 9), 7 patients presented with fever and 1 patient presented with nausea and vomiting (Table 4). The detailed information was shown in Table 4.
Table 4
Adverse events after DEB-TACE
No. | Pain | NRS score | Treatment | Fever | Treatment | Nausea and vomiting | Treatment |
1 | No | N/A | N/A | 39.0℃ | Ibuprofen | No | N/A |
2 | No | N/A | N/A | 39.4℃ | Ibuprofen+indometacin | No | N/A |
3 | No | N/A | N/A | 39.0℃ | Ibuprofen+indometacin | No | N/A |
4 | Yes | 7 | Flurbiprofen | No | N/A | No | N/A |
5 | No | N/A | N/A | No | N/A | No | N/A |
6 | No | N/A | N/A | 39.0℃ | Ibuprofen | No | N/A |
7 | Yes | 8 | Pethidine | No | N/A | No | N/A |
8 | Yes | 8 | Pethidine | 38.6℃ | Ibuprofen+indometacin | No | N/A |
9 | Yes | 5 | Tramadol | 38.0℃ | Ibuprofen | No | N/A |
10 | No | N/A | N/A | No | N/A | No | N/A |
11 | No | N/A | N/A | No | N/A | No | N/A |
12 | Yes | 6 | Tramadol | No | N/A | No | N/A |
13 | No | N/A | N/A | No | N/A | No | N/A |
14 | No | N/A | N/A | No | N/A | Yes | Palonosetron |
15 | Yes | 9 | Pethidine | 38.4℃ | Ibuprofen | No | N/A |
DEB-TACE, drug-eluting bead transarterial chemoembolization; NRS, numerical rating scale. |
Typical Case Report
Mr. Huang, a 56-year-old man was first diagnosed as HCC. Before DEB-TACE treatment, abdominal computed tomography (CT) scan showed that tumor size was 80.49mm*110.82mm (Figure 6A). After identifying the tumor supply artery by hepatic arteriography, DEB-TACE treatment was performed (Figure 6B). After the operation, hepatic arteriography was carried out immediately, which disclosed that the tumor was reduced and the tumor blood supply arteries were almost stagnant (Figure 6C).
Before the surgery, abdominal CT scan showed that tumor size was 40.22mm*64.38mm, which diameter was reduced nearly 5cm (Figure 6D). After resection (Figure 6E, F), the pathological examination was performed (Figure 6G), which discovered drug-loaded microspheres (Figure 6H). This patient was pathologically confirmed HCC with a trend of differentiation of bile duct cell carcinoma (Figure 6I).