Cell apoptosis and regeneration of hepatocellular carcinoma after transarterial chemoembolization

AIM: To evaluate whether cell apoptosis and regeneration were existed in normal liver cells adjacent to carcinoma after transarterial chemoembolization (TACE). METHODS: Fifty rabbits with hepatic carcinoma were divided into 5 groups at random: group A (control group), groups B and C (TACE treatment groups), groups D and E (partial hepatectomy groups). There were 10 rabbits in each group. Rabbits in groups B-E were treated by transarterial chemoembolization (TACE) and partial hepatectomy (PH) respectively. The changes of S-phase cell fraction (SPF), proliferation index (PI) and cell apoptosis in the normal liver tissue were determined with flow cytometry (FCM) after operations on the first and third days. We determined the mitosis index (MI) with histo-pathological method and the apoptosis index (AI) with TUNEL method at the same time. RESULTS: Twenty-four hours after operations, compared with control group, the rabbits in TACE group had much higher index of SPF, PI and MI (MI: t=4.89, P<0.001; SPF:t=5.27, P<0.001; PI: t=4.87, P<0.001). Moreover, the proliferation of liver cells in TACE group was much weaker than that of the cells treated by partial hepatectomy, and the differences were significant (MI: t=7.02, P<0.001; SPF: t=4.06, P<0.001; PI: t=2.70, P<0.05). Seventy-two h after operations, FCM showed a small sub-G1 peak in TACE group and PH group, compared with the control group, but there was no difference between them (t=0.41, P>0.05). TACE showed that AI in the treated rabbits was higher than that in control group (t=3.07, P<0.05), and there were no differences between TACE group and PH group, either (t=0.93, P>0.05). CONCLUSION: Cell apoptosis and regeneration exist in rabbit liver tissues after TACE in some degree, which may be associated with the selective embolization of iodised oil, chemotherapeutic drug and free radical damage.     

Lipiodolized transarterial chemoembolization in hepatocellular carcinoma patients after curative resection

Purpose

To explore the effect of lipiodolized transarterial chemoembolization (lip-TACE) in hepatocellular carcinoma (HCC) patients at different risk of recurrence after curative resection.

Methods

One thousand nine hundred and twenty-four consecutive HCC patients who underwent curative resection were retrospectively analyzed. Patients who underwent resection only were classified into control group, while those received adjuvant lip-TACE were classified into intervention group. Patients were further stratified into 4 groups, that is, tumor ≤5 cm with low or high risk factors, as well as tumor >5 cm with low or high risk factors for recurrence. Tumor number and microscopic tumor thrombus were defined as risk factors for recurrence. The effect of adjuvant lip-TACE on early (<2 year) or late (≥2 year) recurrence was evaluated.

Results

There was no significant difference in recurrence curve between intervention group and control group in each stratum. Adjuvant lip-TACE showed an overall survival benefit in patients with tumor >5 cm and presenting high risk factors, mainly for those with time to recurrence (TTR) <2 years after operation. For them, the median survival was 17 months in the intervention group and 11 months in the control group (P = 0.010). For patients who were confirmed to be recurrence-free at 2 years after operation, it had the negative effect for survival (HR = 1.75, P = 0.004).

Conclusion

Adjuvant lip-TACE had no preventive effect on recurrence, but may be of benefit to detect early recurrence.     

Clostridium perfringens infection after transarterial chemoembolization for large hepatocellular carcinoma

We report an unusual case of Clostridium perfringens liver abscess formation after transcatheter arterialchemoembolization(TACE) for large hepatocellular carcinoma. Severe deterioration in liver and renal function accompanied with hemocytolysis was found on the 2nd day after TACE. Blood culture found Clostridium perfringens and abdominal computed tomography revealed a gas-containing abscess in the liver. Following antibiotics administration and support care, the infection was controlled and the liver and renal function turned normal. The 2nd TACE procedure was performed 1.5 mo later and no recurrent Clostridium perfringens infection was found.     

Microwave ablation of hepatocellular carcinoma with portal vein tumor thrombosis after transarterial chemoembolization: a prospective study

Aims

To prospectively assess the use of microwave ablation (MWA) to treat hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) after transarterial chemoembolization (TACE), and to evaluate factors that significantly affect treatment outcomes.

Methods

Sixty patients with HCC [55 male, 5 female; mean age, 54.1 ± 10.2 (range 36–77) years] + PVTT were enrolled. Patients were treated with MWA after TACE. Results were compared with those of 54 patients treated by TACE alone in another retrospective study. Data analyzed included patient demographics, Eastern Cooperative Oncology Group performance status, liver cirrhosis, liver volume, Child-Pugh class, Cancer of the Liver Italian Program (CLIP) score, and imaging findings. Survival time (from occurrence of PVTT to last follow-up) and predictive factors and their correlation with survival were statistically evaluated.

Results

The median 3-year overall survival (OS) duration was 13.5 months, and the 1- and 3-year OS rates were 48 and 23 %, respectively. Cox hazards regression analysis revealed that change in the neutrophil-to-lymphocyte ratio, CLIP score, and treatment efficacy were the only independent predictive factors for outcome (p = 0.035, 0.024, and 0.000, respectively).

Conclusions

Combination therapy with MWA after TACE may provide a substantial benefit for patients with HCC + PVTT type I, II, or partial III and Child-Pugh class A or B by reducing the tumor burden.

Trial registration number

Chinese Clinical Trial Register (ChiCTR): ChiCTR-ONC-12002689.

     

Adjuvant transarterial chemoembolization after curative resection of hepatocellular carcinoma: Propensity score analysis

AIM: To compare survival and recurrence in hepatocellular carcinoma (HCC) patients who did or did not receive adjuvant transarterial chemoembolization (TACE).METHODS: A consecutive sample of 229 patients who underwent curative resection between March 2007 and March 2010 in our hospital was included. Of these 229 patients, 91 (39.7%) underwent curative resection followed by adjuvant TACE and 138 (60.3%) underwent curative resection alone. In order to minimize confounds due to baseline differences between the two patient groups, comparisons were conducted between propensity score-matched patients. Survival data and recurrence rates were compared using the Kaplan-Meier method. Independent predictors of overall survival and recurrence were identified using Cox proportional hazard regression.RESULTS: Among 61 pairs of propensity score-matched patients, the 1-, 2-, and 3-year overall survival rates were 95.1%, 86.7%, and 76.4% in the TACE group and 86.9%, 78.5%, and 73.2% in the control group, respectively. At the same time, the TACE and control groups also showed similar recurrence rates at 1 year (13.4% vs 24.8%), 2 years (30.6% vs 32.1%), and 3 years (40.1% vs 34.0%). Multivariate Cox regression identified serum alpha-fetoprotein level ≥ 400 ng/mL and tumor size > 5 cm as independent risk factors of mortality (P < 0.05).CONCLUSION: As postoperative adjuvant TACE does not improve overall survival or reduce recurrence in HCC patients, further study is needed to clarify its clinical benefit.     

Risk factors for recurrence after transarterial chemoembolization for early-stage hepatocellular carcinoma

Background

Radiofrequency ablation (RFA) is a standard therapy for the treatment of hepatocellular carcinoma (HCC) with 3 or fewer tumors of up to 3?cm (early-stage HCC); when RFA is unsuccessful or unfeasible, transcatheter arterial chemoembolization (TACE) has often been performed. However, little information about the outcome of TACE for early-stage HCC has been reported and it is hard to decide whether to perform additional treatment following TACE in these difficult conditions. The aim of this study was to determine the risk factors for local or intrahepatic distant recurrence after TACE in early-stage HCC.

Methods

Among 1,560 newly diagnosed HCC patients who were admitted to Okayama University Hospital, 43 patients with early-stage HCC who received only TACE in at least one nodule were enrolled in this study. We analyzed the risk factors for local and distant recurrence by the Cox proportional hazard model.

Results

The local recurrence rates and intrahepatic distant recurrence rates at 3 months, 6?months, and 1?year were 18.6, 33.4, and 61.8%, and 2.8, 2.8, and 10.2%, respectively. Among 12 parameters examined as possible risk factors for recurrence, heterogeneous Lipiodol uptake (risk ratio 3.38; 95% confidence interval 1.14–10.60) and high serum des-gamma-carboxy prothrombin (DCP) (2.58; 1.03–7.14) were significantly correlated with local recurrence, and the presence of multiple tumors (10.64; 1.76–93.75) was significantly correlated with intrahepatic distant recurrence.

Conclusions

Heterogeneous Lipiodol uptake, high serum DCP, and multiple tumors are risk factors for recurrence in patients with early-stage HCC who have undergone palliative TACE.     

Antibiotic prophylaxis in transarterial chemoembolization of hepatocellular carcinoma

Background and study aims

Transarterial chemoembolization remains a common treatment option in unresectable hepatocellular carcinoma. However, protocols for pre- and post-procedure care and the role of antibiotic prophylaxis have not been evaluated. The aim of this work was to compare 3 different groups of prophylactic antibiotics in patients undergoing chemoembolization and to compare the efficacy of intravenous versus oral route.