Survival analysis of 230 patients with unresectable hepatocellular carcinoma treated with bland transarterial embolization

Autoři: Ezio Lanza aff001;  Riccardo Muglia aff002;  Isabella Bolengo aff002;  Dario Poretti aff001;  Felice D’Antuono aff001;  Roberto Ceriani aff003;  Guido Torzilli aff004;  Vittorio Pedicini aff001
Působiště autorů: Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy aff001;  Training School in Radiology, Humanitas University, Pieve Emanuele, Milan, Italy aff002;  Department of Internal Medicine - Hepatology, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy aff003;  Department of Surgery - Hepatobiliary and General Surgery, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy aff004
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227711


Locoregional therapies for hepatocellular carcinoma (HCC) include endovascular treatments such as chemoembolization (TACE) and bland embolization (TAE). TACE is the most adopted technique, despite a lack of definitive evidence of superiority over TAE, which is less costly and better tolerated due to the absence of chemotherapy. However, few studies have reported data on TAE monotherapy for unresectable HCC. We report our results in a cohort of 230 patients with unresectable HCC treated with TAE (TAE with 40-100micron microparticles, TAE with microparticles plus n-butyl-2-cyanoacrylate, TAE with Lipiodol) over the course of seven years. Thirty-seven patients (14%) were down-staged during observation and also received a percutaneous ablation. We observed 1-, 2-, 3-, 4- and 5-year rates of 84,8%, 58,7%, 38,3%, 28,3%, and 18,7%. Patients who also received percutaneous treatment performed best. Our results broaden the body of evidence for the use of TAE in advanced HCC.

Klíčová slova:

Alcoholism – Angiography – Cancer chemotherapy – Cancer treatment – Hepatocellular carcinoma – Oncology – Surgical and invasive medical procedures – Survival analysis


1. Young S, Craig P, Golzarian J. Current trends in the treatment of hepatocellular carcinoma with transarterial embolization: a cross-sectional survey of techniques. Eur Radiol. 2019;29: 3287–3295. doi: 10.1007/s00330-018-5782-7 30350163

2. Facciorusso A, Bellanti F, Villani R, Salvatore V, Muscatiello N, Piscaglia F, et al. Transarterial chemoembolization vs bland embolization in hepatocellular carcinoma: A meta-analysis of randomized trials. United European Gastroenterol J. 2017;5: 511–518. doi: 10.1177/2050640616673516 28588882

3. Colombo GL, Cammà C, Attili AF, Ganga R, Gaeta GB, Brancaccio G, et al. Patterns of treatment and costs of intermediate and advanced hepatocellular carcinoma management in four Italian centers. Ther Clin Risk Manag. 2015;11: 1603–1612. doi: 10.2147/TCRM.S88208 26527877

4. Burroughs A, Hochhauser D, Meyer T. Systemic treatment and liver transplantation for hepatocellular carcinoma: two ends of the therapeutic spectrum. Lancet Oncol. 2004;5: 409–418. doi: 10.1016/S1470-2045(04)01508-6 15231247

5. Oliveri RS, Wetterslev J, Gluud C. Transarterial (chemo)embolisation for unresectable hepatocellular carcinoma. Cochrane Database Syst Rev. 2011; CD004787. doi: 10.1002/14651858.CD004787.pub2 21412886

6. Gbolahan OB, Schacht MA, Beckley EW, LaRoche TP, O’Neil BH, Pyko M. Locoregional and systemic therapy for hepatocellular carcinoma. J Gastrointest Oncol. 2017;8: 215–228. doi: 10.21037/jgo.2017.03.13 28480062

7. Lanza E, Donadon M, Felisaz P, Mimmo A, Chiti A, Torzilli G, et al. Refining the management of patients with hepatocellular carcinoma integrating 11C-choline PET/CT scan into the multidisciplinary team discussion. Nucl Med Commun. 2017;38: 826–836. doi: 10.1097/MNM.0000000000000719 28723716

8. European Association for the Study of the Liver. Electronic address:, European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69: 182–236. doi: 10.1016/j.jhep.2018.03.019 29628281

9. Young S, Taylor AJ, Sanghvi T. Post Locoregional Therapy Treatment Imaging in Hepatocellular Carcinoma Patients: A Literature-based Review. J Clin Transl Hepatol. 2018;6: 189–197. doi: 10.14218/JCTH.2017.00059 29951364

10. Kudo M, Trevisani F, Abou-Alfa GK, Rimassa L. Hepatocellular carcinoma: therapeutic guidelines and medical treatment. Liver Cancer. 2016;6: 16–26. doi: 10.1159/000449343 27995084

11. Bonomo G, Pedicini V, Monfardini L, Della Vigna P, Poretti D, Orgera G, et al. Bland embolization in patients with unresectable hepatocellular carcinoma using precise, tightly size-calibrated, anti-inflammatory microparticles: first clinical experience and one-year follow-up. Cardiovasc Intervent Radiol. 2010;33: 552–559. doi: 10.1007/s00270-009-9752-y 19957182

12. Wáng Y-XJ, De Baere T, Idée J-M, Ballet S. Transcatheter embolization therapy in liver cancer: an update of clinical evidences. Chin J Cancer Res. 2015;27: 96–121. doi: 10.3978/j.issn.1000-9604.2015.03.03 25937772

13. Monsignore LM, Elias-Junior J, Muglia VF, Teixeira AC, Mente ED, Martinelli AL, et al. Addition of n-butyl cyanoacrylate to classic transarterial chemoembolization may improve the radiological response in patients with hepatocellular carcinoma. Clinics. 2015;70: 781–789. doi: 10.6061/clinics/2015(12)04 26735217

14. Berghammer P, Pfeffel F, Winkelbauer F, Wiltschke C, Schenk T, Lammer J, et al. Arterial hepatic embolization of unresectable hepatocellular carcinoma using a cyanoacrylate/lipiodol mixture. Cardiovasc Intervent Radiol. 1998;21: 214–218. doi: 10.1007/s002709900247 9626437

15. Lanza E, Muglia R, Solbiati LA, Tramarin M, Poretti D, Pedicini V. Emergency transarterial embolization in postoperative hip bleeding: indications, techniques, and results in a retrospective cohort. J Arthroplasty. 2018;33: 2273–2278. doi: 10.1016/j.arth.2018.02.005 29544971

16. Pedicini V, Santonocito OG, Poretti D, Tramarin M, Lanza E. Iatrogenic Pulmonary Pseudoaneurysm Treated with Percutaneous Coil and Glue Embolization. J Vasc Interv Radiol. 2017;28: 1444–1445. doi: 10.1016/j.jvir.2017.06.020 28941519

17. Lanza E, Poretti D, Tramarin M, Pedicini V, Balzarini L. Colonic ischemia, perforation, and colectomy after a complicated endovascular embolization for type II endoleak with the use of cyanoacrylate glue. J Vasc Interv Radiol. 2014;25: 1482–1484. doi: 10.1016/j.jvir.2014.05.018 25150908

18. Idée J-M, Guiu B. Use of Lipiodol as a drug-delivery system for transcatheter arterial chemoembolization of hepatocellular carcinoma: a review. Crit Rev Oncol Hematol. 2013;88: 530–549. doi: 10.1016/j.critrevonc.2013.07.003 23921081

19. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology. 2003;37: 429–442. doi: 10.1053/jhep.2003.50047 12540794

20. Yu SCH, Hui JWY, Hui EP, Chan SL, Lee KF, Mo F, et al. Unresectable hepatocellular carcinoma: randomized controlled trial of transarterial ethanol ablation versus transcatheter arterial chemoembolization. Radiology. 2014;270: 607–620. doi: 10.1148/radiol.13130498 24126369

21. Kawai S, Okamura J, Ogawa M, Ohashi Y, Tani M, Inoue J, et al. Prospective and randomized clinical trial for the treatment of hepatocellular carcinoma—a comparison of lipiodol-transcatheter arterial embolization with and without adriamycin (first cooperative study). The Cooperative Study Group for Liver Cancer Treatment of Japan. Cancer Chemother Pharmacol. 1992;31 Suppl: S1–6. doi: 10.1007/bf00687096 1281041

22. Lin DY, Liaw YF, Lee TY, Lai CM. Hepatic arterial embolization in patients with unresectable hepatocellular carcinoma—a randomized controlled trial. Gastroenterology. 1988;94: 453–456. doi: 10.1016/0016-5085(88)90436-2 2826285

23. Meyer T, Kirkwood A, Roughton M, Beare S, Tsochatzis E, Yu D, et al. A randomised phase II/III trial of 3-weekly cisplatin-based sequential transarterial chemoembolisation vs embolisation alone for hepatocellular carcinoma. Br J Cancer. 2013;108: 1252–1259. doi: 10.1038/bjc.2013.85 23449352

24. Bruix J, Llovet JM, Castells A, Montañá X, Brú C, Ayuso MC, et al. Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology. 1998;27: 1578–1583. doi: 10.1002/hep.510270617 9620330

25. Chang JM, Tzeng WS, Pan HB, Yang CF, Lai KH. Transcatheter arterial embolization with or without cisplatin treatment of hepatocellular carcinoma. A randomized controlled study. Cancer. 1994;74: 2449–2453. doi: 10.1002/1097-0142(19941101)74:9<2449::aid-cncr2820740910>;2-4 7922999

26. Llovet JM, Real MI, Montaña X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002;359: 1734–1739. doi: 10.1016/S0140-6736(02)08649-X 12049862

27. Malagari K, Pomoni M, Kelekis A, Pomoni A, Dourakis S, Spyridopoulos T, et al. Prospective randomized comparison of chemoembolization with doxorubicin-eluting beads and bland embolization with BeadBlock for hepatocellular carcinoma. Cardiovasc Intervent Radiol. 2010;33: 541–551. doi: 10.1007/s00270-009-9750-0 19937027

28. Lanza E, Donadon M, Poretti D, Pedicini V, Tramarin M, Roncalli M, et al. Transarterial therapies for hepatocellular carcinoma. Liver Cancer. 2016;6: 27–33. doi: 10.1159/000449347 27995085

29. Loewe C, Cejna M, Schoder M, Thurnher MM, Lammer J, Thurnher SA. Arterial Embolization of Unresectable Hepatocellular Carcinoma with Use of Cyanoacrylate and Lipiodol. J Vasc Interv Radiol. 2002;13: 61–69. doi: 10.1016/s1051-0443(07)60010-4 11788696

30. Prajapati HJ, Xing M, Spivey JR, Hanish SI, El-Rayes BF, Kauh JS, et al. Survival, efficacy, and safety of small versus large doxorubicin drug-eluting beads TACE chemoembolization in patients with unresectable HCC. AJR Am J Roentgenol. 2014;203: W706–14. doi: 10.2214/AJR.13.12308 25415737

31. Bouvier A, Ozenne V, Aubé C, Boursier J, Vullierme MP, Thouveny F, et al. Transarterial chemoembolisation: effect of selectivity on tolerance, tumour response and survival. Eur Radiol. 2011;21: 1719–1726. doi: 10.1007/s00330-011-2118-2 21479978

32. Marelli L, Stigliano R, Triantos C, Senzolo M, Cholongitas E, Davies N, et al. Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol. 2007;30: 6–25. doi: 10.1007/s00270-006-0062-3 17103105

33. Katsanos K, Kitrou P, Spiliopoulos S, Maroulis I, Petsas T, Karnabatidis D. Comparative effectiveness of different transarterial embolization therapies alone or in combination with local ablative or adjuvant systemic treatments for unresectable hepatocellular carcinoma: A network meta-analysis of randomized controlled trials. PLoS ONE. 2017;12: e0184597. doi: 10.1371/journal.pone.0184597 28934265

34. Wang Y, Ma L, Yuan Z, Zheng J, Li W. Percutaneous thermal ablation combined with TACE versus TACE monotherapy in the treatment for liver cancer with hepatic vein tumor thrombus: A retrospective study. PLoS ONE. 2018;13: e0201525. doi: 10.1371/journal.pone.0201525 30063737

35. Chevallier P, Baudin G, Anty R, Guibal A, Chassang M, Avril L, et al. Treatment of hepatocellular carcinomas by thermal ablation and hepatic transarterial chemoembolization. Diagn Interv Imaging. 2015;96: 637–646. doi: 10.1016/j.diii.2015.04.006 25981213

Článek vyšel v časopise


2020 Číslo 1