Journal of vascular and interventional radiology : JVIR · 2025
Outcomes of Transarterial Hepatic Embolization versus Yttrium-90 Radioembolization for Treatment of Patients with Hepatocellular Carcinoma >7 cm.
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Son Sam Y, Velayati Sara, Zhao Ken, Marinelli Brett, Geevarghese Ruben, Sotirchos Vlasios S, Covey Anne, Harding James J, D'Angelica Michael I, Jarnagin William R, Wei Alice, Yarmohammadi Hooman
Аннотация
PURPOSE: To assess and compare the safety, effectiveness, and outcomes of transarterial hepatic embolization (TAE) and transarterial radioembolization (TARE) for the treatment of patients with unresectable hepatocellular carcinoma (HCC) >7 cm.
MATERIALS AND METHODS: Treatment-naive patients with HCC >7 cm who were treated with TAE or TARE between January 2013 and December 2023 were reviewed in this retrospective study. Nearest neighbor 2:1 propensity score matching was utilized for direct comparison. Radiological treatment response was assessed using the modified Response Evaluation Criteria in Solid Tumours (mRECIST). Kaplan-Meier survival curves were used to estimate progression-free survival (PFS) and overall survival (OS). Log-rank tests were performed to compare survival curves.
RESULTS: A total of 125 patients with HCC >7 cm were treated with TAE (n = 103) or TARE (n = 22). After propensity score matching, 44 patients who underwent TAE and 22 patients who were treated with TARE were compared. The mean tumor sizes were 10.4 cm (SD ± 2.6) in the TAE group and 10.7 cm (SD ± 2.7) in the TARE group (P > .695). TAE and TARE exhibited comparable adverse event (AE) rates (Grade 1 AE in 22 [50%] of 44 in TAE and 6 [27%] of 22 in TARE, P = .999; 1 Grade 2 AE [4.5%] in TAE). Median OS durations were 15.2 and 23.6 months in the TAE and TARE groups, respectively (P = .252). Median local PFS (4.7 vs 21.6 months, P < .001) and PFS (3.6 vs 10.0 months, P = .002) were significantly longer after TARE. TAE and TARE had similar objective response rates (TAE, 88.6% vs TARE, 77.3%; P = .364). Systemic therapy after TAE or TARE was a significant positive prognostic factor associated with freedom from disease progression and survival (PFS hazard ratio [HR], 0.58 [P = .047]; OS HR, 0.33 [P < .001]).
CONCLUSIONS: TAE and TARE are both safe transarterial therapies for patients with HCC >7 cm. TARE is associated with a longer time to progression and longer OS.
MATERIALS AND METHODS: Treatment-naive patients with HCC >7 cm who were treated with TAE or TARE between January 2013 and December 2023 were reviewed in this retrospective study. Nearest neighbor 2:1 propensity score matching was utilized for direct comparison. Radiological treatment response was assessed using the modified Response Evaluation Criteria in Solid Tumours (mRECIST). Kaplan-Meier survival curves were used to estimate progression-free survival (PFS) and overall survival (OS). Log-rank tests were performed to compare survival curves.
RESULTS: A total of 125 patients with HCC >7 cm were treated with TAE (n = 103) or TARE (n = 22). After propensity score matching, 44 patients who underwent TAE and 22 patients who were treated with TARE were compared. The mean tumor sizes were 10.4 cm (SD ± 2.6) in the TAE group and 10.7 cm (SD ± 2.7) in the TARE group (P > .695). TAE and TARE exhibited comparable adverse event (AE) rates (Grade 1 AE in 22 [50%] of 44 in TAE and 6 [27%] of 22 in TARE, P = .999; 1 Grade 2 AE [4.5%] in TAE). Median OS durations were 15.2 and 23.6 months in the TAE and TARE groups, respectively (P = .252). Median local PFS (4.7 vs 21.6 months, P < .001) and PFS (3.6 vs 10.0 months, P = .002) were significantly longer after TARE. TAE and TARE had similar objective response rates (TAE, 88.6% vs TARE, 77.3%; P = .364). Systemic therapy after TAE or TARE was a significant positive prognostic factor associated with freedom from disease progression and survival (PFS hazard ratio [HR], 0.58 [P = .047]; OS HR, 0.33 [P < .001]).
CONCLUSIONS: TAE and TARE are both safe transarterial therapies for patients with HCC >7 cm. TARE is associated with a longer time to progression and longer OS.