Correlation Between The Dosage Of Microspheres And Tumor Feeding Artery Area During D-TACE And Clinical Application Of Blood Vessel Density (BVD)

BackgroundTranscatheter arterial chemoembolization(TACE)is considered as the first-line palliative treatment for unresectable HCC patients.Due to the local deposition of lipiodol emulsion,the cytotoxic effect of drugs on tumors will decrease with time.DEB-TACE is used to treat primary liver cancer(PLC)to overcome these shortcomings,to ensure continuous selective drug delivery of tumors and to realize permanent embolization of tumor blood supply.Previous observations suggest that the amount of embolization used during surgery is related to the volume of the tumor.But clinical work can be found that embolization of vascular-enriched tumors requires embolization of tumors that are vascular-deficient in the same tumor volume.At the same time,clinical studies have pointed out that the dosage of iodized oil most commonly reported by c-TACE is as high as 10ml.It is also recommended that adults use 15ml or less each time,while using more than 20ml may lead to life-threatening adverse events,including liver failure and lung toxicity caused by liver shunting to the lungs.There is no objective definition of tumor vascular enrichment degree in clinic.Microvessel density(MVD)is the most widely used method to evaluate angiogenesis.It is defined as the number of blood vessels per unit area in a tissue section under high magnification.MVD can reflect the blood vessel enrichment degree of tumor microscopically,but it is difficult to apply in clinical diagnosis and treatment.Therefore,it is necessary to use an index that is easy to measure during routine diagnosis and treatment to reflect the degree of tumor vessel enrichment.PurposeIn this study,ImageJ software was used to try to find out the objective description of the degree of tumor vascular enrichment and the quantitative relationship between the degree of tumor vascular enrichment and the amount of embolization in TACE.Try to find out the relationship between the area of the feeding artery of primary liver cancer and the amount of embolism during TACE,and use the vascular density(BVD)to objectively reflect the degree of vascular enrichment of liver cancer.Materials and MethodsThis retrospective review included 187 patients with primary liver cancer who treated by DEB-TACE.According to the exclusion and inclusion criteria,122 patients were included.There were 96 males and 26 females,aged 29-70 years with an average of 52 years.The lesion size was 3-15.0cm,with an average of 8.9cm;.Child-pugh classification of liver function:50 cases with grade A and 72 cases with grade B;85 cases were pathologically confirmed,60 cases were hepatocellular carcinoma,24 cases were cholangiocarcinoma,and 1 case was mixed type.TTP,complications and serious side effects,causes of death,survival time,and operation completion of the patients were followed up,and the corresponding tumor feeding artery area and vascular density were measured.Results(1)Linear regression analysis was carried out on the tumor feeding artery area and embolic dose of 122 patients,and it was found that the two were positively correlated,R2-0.657,P<0.001).(2)The vascular density d of hepatocellular carcinoma and cholangiocarcinoma were tested by independent sample t,F=21.058,P=0.000<0.05,t=-3.302,sig(bilateral)0.002<0.05.Conclusions(1)there was a linear correlation between the area of tumor blood supply artery and the amount of drug-loaded microspheres during DSA(P<0.001).(2)Tumor vascular density(BVD)can reflect the difference in vascular enrichment between hepatocellular carcinoma and cholangiocarcinoma,and is expected to be a promising biomarker for evaluating tumor progression.