Pathological response after degradable starch microspheres transarterial chemoembolization for hepatocellular carcinoma: a Histopathological study on explanted livers.

PURPOSE: To evaluate the pathological response after degradable starch microspheres transarterial chemoembolization (DSM-TACE) conducted to bridge or downstage hepatocellular carcinoma (HCC) patients to liver transplantation.

MATERIALS AND

METHODS

A multi-center retrospective study was conducted on consecutive patients with HCC who underwent liver transplantation after receiving DSM-TACE as a stand-alone therapy for bridging or downstaging between January 1, 2010, and December 31, 2022. Pathological response was evaluated histologically by board certified surgical pathologists. Tumor necrosis was estimated histologically as a percentage area of the total tumor area. The criteria for estimation of pathological response were established as follows: (1) Complete pathological response: 100% tumor necrosis and absence of any viable tumor cells; (2) Significant pathological response: 50-99% tumor necrosis in cross section; (3) Mild pathological response: 1-49% tumor necrosis in cross section and (4) No pathological response: no tumor necrosis present.

RESULTS

Twenty-two patients (16 men; median age, 65 years) with 73 HCCs (median largest diameter: 2.7 cm) were bridged or downstaged with DSM-TACE and subsequently underwent liver transplantation. Histopathological examination of the explanted livers showed complete pathological response in 27 % of patients, significant pathological response in 32 %, mild pathological response in 27 % and no pathological response in 14 %.

CONCLUSION

The present study provides important clinical evidence supporting the efficacy of DSM-TACE in inducing tumor necrosis, despite its short embolization time.