Drug-Eluting Bead Transarterial Chemoembolization Combined with FOLFOX-Based Hepatic Arterial Infusion Chemotherapy for Large or Huge Hepatocellular Carcinoma

Abstract

Jingjun Huang,1,* Wensou Huang,1,* Meixiao Zhan,2,* Yongjian Guo,1 Licong Liang,1 Mingyue Cai,1 Liteng Lin,1 Mingji He,3 Hui Lian,3 Ligong Lu,2 Kangshun Zhu1 1Department of Interventional Radiology, Minimally Invasive and Interventional Cancer Center, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou City, Guangdong Province, People’s Republic of China; 2Zhuhai Interventional Medical Center, Zhuhai Precision Medical Center, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai City, Guangdong Province, People’s Republic of China; 3Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou City, Guangdong Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Kangshun ZhuDepartment of Interventional Radiology, Minimally Invasive and Interventional Cancer Center, The Second Affiliated Hospital of Guangzhou Medical University, 250 East Changgang Road, Guangzhou City, Guangdong, 510260, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected] LuZhuhai Interventional Medical Center, Zhuhai Precision Medical Center, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, 79 Kangning Road, Zhuhai City, Guangdong Province, 519000, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected]: To evaluate the safety and efficacy of drug-eluting bead transarterial chemoembolization (DEB-TACE) combined with oxaliplatin plus fluorouracil and leucovorin (FOLFOX)-based hepatic arterial infusion chemotherapy (D-TACE-HAIC) for unresectable large (5.1– 10 cm) or huge (> 10 cm) hepatocellular carcinoma (HCC).Methods: This retrospective study evaluated consecutive patients with unresectable large or huge HCC who underwent D-TACE-HAIC (D-TACE-HAIC group) or DEB-TACE (DEB-TACE group) from January 2017 to December 2020. At imaging, tumor infiltrating appearance was classified into smooth tumor margin, non-smooth tumor margin, and macrovascular invasion. Adverse events, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were compared between the two groups.Results: A total of 133 patients (mean age, 53 years ± 12; 117 men) were included: 69 underwent D-TACE-HAIC and 64 underwent DEB-TACE. The patients who underwent D-TACE-HAIC had higher ORR (71.0% vs 53.1%; P = 0.033), longer PFS (median, 9.3 vs 6.3 months; P = 0.005), and better OS (median, 19.0 vs 14.0 months; P = 0.008) than those who underwent DEB-TACE. In subgroup analysis, patients with non-smooth tumor margin (median, 20.8 vs 13.0 months; P = 0.031) or macrovascular invasion (median, 15.0 vs 11.0 months; P = 0.015) had significantly longer OS in D-TACE-HAIC group than in DEB-TACE group; but in patients with smooth tumor margin, OS between the two groups was similar (median, 37.0 vs 35.0 months; P = 0.458). DEB-TACE, non-smooth tumor margin, and macrovascular invasion were independent prognostic factors for poor OS in uni- and multivariable analyses. The incidence of grade 3/4 adverse events was not statistically different between the two groups (37.7% vs 28.1%; P = 0.242).Conclusion: D-TACE-HAIC was tolerable and led to better OS than DEB-TACE in patients with large or huge HCC, especially in those with non-smooth tumor margin or macrovascular invasion.Keywords: liver cancer, high tumor burden, chemoembolization, drug-eluting beads, hepatic arterial infusion chemotherapy, survival analysis

Keywords

• liver cancer
• high tumor burden
• chemoembolization
• drug-eluting beads
• hepatic arterial infusion chemotherapy
• survival analysis