Drug-eluting bead transarterial chemoembolization is an effective downstaging option for subsequent radical treatments in patients with hepatocellular carcinoma: A cohort study

• Published in: Clinics and research in hepatology and gastroenterology 2021-07, Vol.45 (4), p.101535-101535, Article 101535
• Main Authors: Cai, Liang, Li, Honglu, Guo, Jiang, Zhao, Wenpeng, Duan, Youjia, Hou, Xiaopu, Cheng, Long, Du, Hongliu, Shao, Xihong, Diao, Zhenying, Li, Changqing
• Format: Article
• Language: English
• Subjects: alpha-Fetoproteins; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic; Cohort Studies; Down-staging; Drug-eluting bead transarterial chemoembolization; Hepatocellular carcinoma; Humans; Liver Neoplasms - therapy; Pharmaceutical Preparations; Survival profiles; Treatment Outcome; Treatment response
• ISSN: 2210-7401; 2210-741X
• DOI: 10.1016/j.clinre.2020.09.002

•59.4% unresectable HCC patients had successful down-staging after DEB-TACE, and followed radical treatment reached CR of 81.3%.•CNLC stage (IIb vs. IIa) was an independent factor for non-successful down-stating in unresectable HCC patients.•Successful down-staging was correlated with longer PFS and OS, and was an independent factor for increased OS in unresectable HCC patients. This study aimed to investigate the potential of drug-eluting bead transarterial chemoembolization (DEB-TACE) as downstaging therapy for subsequent radical treatment in patients with hepatocellular carcinoma (HCC). Totally, 32 patients with unresectable HCC were enrolled, then they received DEB-TACE for down-staging therapy followed by radical treatments (surgery, radiofrequency ablation or microwave ablation). The rate of successful down-staging, treatment response (after DEB-TACE and radical therapy), alpha-fetoprotein (AFP), progression-free survival (PFS) and overall survival (OS) were assessed. After down-staging therapy with DEB-TACE, successful down-staging rate was 59.4%. With the followed radical treatment, the complete response was 81.3%. Subsequent analysis indicated that CNLC stage (IIb vs. IIa) was an independent risk factor for successful down-staging. Furthermore, AFP level presented a declined trend throughout the time points (before DEB-TACE, after DEB-TACE, and after radical treatment). Additionally, 1-year, 2-year and 3-year accumulating PFS were 68.8%, 40.6% and 31.3%, respectively; 1-year, 2-year and 3-year accumulating OS were 84.4%, 71.9% and 53.1%, respectively. Kaplan-Meier curves exhibited that successful down-staging was correlated with longer PFS and OS, then further Cox’s regression analysis verified that successful down-staging was an independent factor for predicting increased OS but not PFS. Besides, child-Pugh stage (B vs. A), CNLC stage (IIb vs. IIa) and AFP abnormal after radical treatment were independent factors for decreased PFS or OS. DEB-TACE has potential as an additionally effective down-staging therapy for radical treatments, and successful down-staging treatment by DEB-TACE associates with favorable survival profiles in patients with unresectable HCC.