Efficacy And Safety Analysis Of Drug-eluting Beads Transarterial Chemoembolization With Sequential Lipiodol Labeling Combined With Thermal Ablation Versus Drug-eluting Beads Transarterial Chemoembolization Alone In Patients With Intermediate And Advanced

Background and Objective:Hepatocellular carcinoma(HCC)is the most common primary liver cancer.Due to its insidious onset and rapid progression,most patients are already in the intermediate or advanced stage when they are firstly diagnosed.Using drug-eluting beads as embolization material can reduce the systemic chemotherapeutic drug concentration after transarterial chemoembolization(TACE)and make it easier to standardize.Some studies have reported its effects on improving treatment response,long-term survival and reducing systemic toxicity.Lipiodol labeling is not only helpful for the detection of liver cancers with a diameter of ≤ 2cm that are easily missed by computed tomography(CT)/ magnetic resonance imaging(MRI)before surgery,but also makes the ablation range more accurate.The ablation therapy can not only reduce the number of transarterial chemoembolization treatments,but also shows the efficacy and survival comparable to surgical resection in lesions with a diameter of ≤ 2 cm.This study explored the efficacy and safety of drug-eluting beads transarterial embolization with sequential lipiodol labeling combined with thermal ablation versus drug-eluting beads transarterial embolization alone in patients with intermediate and advanced hepatocellular carainoma,and analyzed the influencing factors of the patients’ curative effect and prognosis.Material and Methods:A total of 86 patients with unresectable intermediate and advanced hepatocellular carainoma treated by the department of Minimal-Invasive Intervention,the Affiliated Cancer Hospital of Zhengzhou University from January 2018 to January 2020 were enrolled,including 45 cases in the drug-eluting beads transarterial embolization with sequential lipiodol labeling combined with thermal ablation group and 41 cases in the drug-eluting beads transarterial embolization alone group.The clinical data of all enrolled patients were retrospectively analyzed.The modified response evaluation criteria in solid tumors(m RECIST)was used to evaluate the efficacy after treatments,and the progression free survival(PFS),overall survival(OS),and treatment-related adverse events and complications of all patients were recorded.The prognostic factors affecting the efficacy,PFS and OS were evaluated through univariate and multivariate analysis.Result:The proportion of patients who achieved complete response(CR)and objective response rate(ORR)in the drug-eluting beads transarterial embolization with sequential lipiodol labeling combined with thermal ablation group were better than those in the drug-eluting beads transarterial embolization alone group(46.4% vs13.3%,P=0.001),(85.4% vs 66.7%,P=0.044).Multivariate logistic regression analysis showed that drug-eluting beads transarterial embolization with sequential lipiodol labeling combined with thermal ablation therapy(P=0.012)was an independent predictor of improvement in CR,while vascular invasion(P=0.045)was an independent predictor of worsening CR.The median PFS of the drug-eluting beads transarterial embolization with sequential lipiodol labeling combined with thermal ablation group was better than that of the drug-eluting beads transarterial embolization alone group(10 months vs 8 months,P=0.041).The median OS of the drug-eluting beads transarterial embolization with sequential lipiodol labeling combined with thermal ablation group was better than that of the drug-eluting beads transarterial embolization alone group(28 months vs 19 months,P=0.005).Multivariate Cox proportional hazard regression model analysis showed that drug-eluting beads transarterial embolization with sequential lipiodol labeling combined with thermal ablation therapy(P=0.037)was an independent predictor of PFS improvement,and the number of tumors > 5(P=0.033)was an independent predictors of PFS shortening.Drug-eluting beads transarterial embolization with sequential lipiodol labeling combined with thermal ablation therapy(P=0.021)was an independent predictor of OS improvement,and vascular invasion(P=0.030)was an independent predictor of OS shortening.There was no significant difference in the incidence of adverse events and complications between the two groups.Conclusion:Drug-eluting beads transarterial embolization with sequential lipiodol labeling combined with thermal ablation therapy has a better therapeutic response than drug-eluting beads transarterial embolization alone in patients with unresectable intermediate and advanced hepatocellular carainoma,and can better prolong the PFS and OS,and there is no significant difference in the incidence of adverse events and complications between the two treatments.Multivariate analysis shows that drug-eluting beads transarterial embolization with sequential lipiodol labeling combined with thermal ablation therapy is an independent predictor of improvement in CR,while vascular invasion is an independent predictor of worsening CR;Drug-eluting beads transarterial embolization with sequential lipiodol labeling combined with thermal ablation therapy is an independent predictor of PFS improvement,and the number of tumors > 5 is an independent predictor of PFS shortening;Drug-eluting beads transarterial embolization with sequential lipiodol labeling combined with thermal ablation therapy is an independent predictor of OS improvement,and vascular invasion is an independent predictor of OS shortening.