Background: To compare the efficacy and safety of transarterial chemoembolization (TACE) combined with lenvatinib vs TACE alone in intermediate-stage hepatocellular carcinoma (HCC) patients with hypovascular nodules. Methods: This retrospective study analyzed the clinical data of intermediate-stage HCC patients with hypovascular nodules who underwent TACE. Patients were categorized into the TACE-Lenv combination group and the TACE monotherapy group according to their receipt of lenvatinib therapy. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), progression of hypovascular nodules, and treatment-related adverse events were recorded and analyzed. Results: The study enrolled 75 patients, with 40 allocated to the TACE-Lenv group and 35 to the TACE group. The combination therapy group demonstrated significantly higher ORR and DCR (92.5% vs 74.3%, P = .032; 97.5% vs 82.9%, P = .030) compared with TACE monotherapy. The TACE-Lenv group exhibited significantly prolonged median OS and PFS (41.1 vs 19.7 months, P < .001; 20.2 vs 9.9 months, P < .001). In addition, compared with the TACE group, the TACE-Lenv group extended the median time to nodule progression (37.0 vs 16.5 months, P < .001). After propensity score matching, significant differences remained in the aforementioned outcomes between the 2 groups. No significant differences were observed in liver function parameters or the incidence of grade 3 to 4 AEs between the 2 groups after treatment. Conclusions: The combination therapy of TACE and lenvatinib demonstrated excellent clinical efficacy in intermediate-stage HCC with hypovascular nodules and may therefore emerge as a preferred treatment option for this specific patient population.

PURPOSE:To compare the safety and efficacy of hepatic arterial infusion chemotherapy followed by transarterial embolization (HAIC+TAE) to transarterial chemoembolization (TACE) for the treatment of unresectable hepatocellular carcinoma (uHCC). MATERIALS AND METHODS:The clinical data of patients who received HAIC+TAE or TACE between April 2020 and April 2022 was collected. Propensity score-matching was used to balance the baseline characteristics of the two groups. Tumor response according to mRECIST, median time to progression (TTP) and overall survival (OS) were investigated. ALBI score was applied to evaluate the changes of liver function and other relative adverse reactions were recorded. RESULTS:A total of 98 patients with uHCC were enrolled in the study, including 71 in the TACE group and 27 in the HAIC+TAE group. After propensity score matching, 23 pairs of patients were investigated. The HAIC+TAE group showed a longer median TTP and OS than TACE group (mTTP 316 vs. 235 days, P=0.023; mOS 580 vs. 493 days, P=0.020). Objective response rates in HAIC+TAE group and TACE group were 65.2% and 47.8% (P=0.234). Disease-control rates were 87.0% and 82.6% (P=1.000). No significant difference was found in the incidence of adverse events between the two groups (P>0.05). CONCLUSION:The combination treatment strategy of HAIC+TAE in patients with uHCC appears to be a safe regimen, with the potential to prolong mTTP and mOS relative to TACE. The sequential application of this therapy merits consideration as an innovative treatment strategy for individuals with uHCC.

Purpose:To evaluate the efficacy and safety of a multimodal therapeutic approach involving transarterial chemoembolization (TACE) in conjunction with helical iodine-125 (I-125) seed implant, lenvatinib, and programmed cell death-1(PD-1) inhibitors for hepatocellular carcinoma (HCC) complicated by main portal vein tumor thrombus (MPVTT). Material and methods:HCC patients with MPVTT treated with TACE coupled with helical I-125 implant, lenvatinib, PD-1 inhibitors between September 2019 and August 2022 were retrospectively analyzed, and constituted as study group. Those treated with TACE, helical I-125 seed implant, and sorafenib between December 2016 and August 2020 served as the historical control group. All patients received sorafenib or lenvatinib combined with PD-1 inhibitors within 3-7 days after TACE and helical I-125 seed implantation. The longest follow-up period for all patients in both groups was 36 months from the date of helical I-125 seed implantation. Primary outcome was overall survival time (OS), and secondary outcomes were progression free survival time (PFS), objective response rate (ORR), and disease control rate (DCR). The Cox proportional hazards regression model was employed to identify independent prognostic factors influencing OS and PFS. The value P < 0.05 was deemed statistically significant. Results:A total of 53 patients were enrolled, with 22 assigned to the study group and 31 to the control group. The study group exhibited superior overall ORR(54.5% vs. 25.8%, P = 0.033) and overall DCR (77.3% vs. 64.5%, P = 0.319). Notably, the ORR and DCR of MPVTT were higher in the study group (86.4% vs. 51.6%, P = 0.008; and 95.5% vs. 83.9%, P = 0.382, respectively). Median OS (16.1 ± 6.1 months vs. 10.2 ± 0.8 months, P = 0.008) and PFS (13.6 ± 3.0 months vs. 6.1 ± 0.6 months, P = 0.014) were prolonged in the study group. The maximal tumor size, alpha fetoprotein level, and treatment modality were independent predictors for OS, while the maximal tumor size and treatment modality were independent determinants for PFS. Study group showed frequent hypothyroidism and reactive cutaneouscapillary (P < 0.01), with comparable grade 3/4 adverse events between groups. Conclusions:The integration of the helical I-125 seed implant with TACE, lenvatinib, and PD-1 inhibitors is the safe and efficacious approach in the management of HCC complicated by MPVTT.

Transarterial chemoembolization (TACE) is recommended as the first-line approach for intermediate hepatocellular carcinoma (HCC), and it is the most widely applied method for advanced HCC in real-world clinical practice.[1,2] According to the China Liver Cancer (CNLC) staging system, TACE is recommended as the first-line therapy for stages IIb and IIIa, while it is also recommended as a major approach for stages Ib, IIa, and IIIb.[3] Despite its confirmed treatment efficacy and safety, repeated TACE is sometimes unbeneficial for some patients due to the high heterogenicity of HCC, manifesting as liver function deterioration and occupying the optimal occasion of other therapies. Accordingly, the concept of "TACE refractoriness" has been introduced by various societies around the world to avoid ineffective repeated TACE.[4] Nevertheless, there is no widely accepted consensus on the definitions of "TACE refractoriness" and some controversies have yet to be resolved. In addition, whether the existing definitions of "TACE refractoriness" are suitable for Chinese HCC is still doubtful. Currently, three versions of "TACE refractoriness" definitions have been introduced by the Japan Society of Hepatology (JSH) (Kyoto, Japan), the International Association for the Study of the Liver (Shanghai, China), and a European expert panel. Among them, the 2014 updated version of "TACE refractoriness" introduced by the JSH is most widely applied in clinical trials.[4] Different from Western countries and Japan in patient with HCC, Chinese HCCs are mostly diagnosed at more advanced stages and patients treated with TACE generally have a higher tumor burden.[5] Therefore, it is doubtful and remains to be discussed whether the currently definitions of "TACE refractoriness" are suitable for Chinese HCCs. To obtain a comprehensive understanding of the recognition of TACE refractoriness in China, the Chinese College of Interventionalists (CCI) carried out a survey in 2020.[6] A total of 257 physicians with more than 10 years of experience in the treatment of HCC attended the survey. Nearly three quarters (74.3%, n = 191) of the attending interventionalists agreed that the concept of "TACE refractoriness" has scientific and clinical significance. Nearly half (47.1%, n = 121) of the participants disagreed with the perspective that new occurrence of intrahepatic lesion(s) should be regarded as TACE refractoriness and, by contrast, only a fraction (16.3%, n = 42) of participants held opposite opinion. Notably, many of the participants (29.2%, n = 75) agreed that progression of the treated lesion(s) after three consecutive TACE sessions should be regarded as TACE refractoriness and thereafter triggered other therapies. Whereas, most interventionalists insisted that repeated TACE still be beneficial for intrahepatic lesion(s) even in cases of post-TACE macrovascular invasion (94.2%, n = 242) or extrahepatic metastasis (98.4%, n = 253) for patients with preserved liver function. As such, most participants (91.4% n = 235) believed that none of the existing "TACE refractoriness" definitions were suitable for Chinese HCC, and thus it was urgent to redefine this concept to meet the need for TACE management of HCC in China. Based on the available evidence and opinions from experts in China, the CCI definition and consensus statement on "TACE refractoriness" was introduced by the CCI TACE Refractoriness Collaboration Group in 2021. The formulation of the CCI definition and consensus statement on "TACE refractoriness" aims to introduce more reliable concepts of "TACE refractoriness" to better guide the clinical practice of TACE for patients with HCC in China. The evidence quality and recommendation level of the consensus statement were based on the grading method of the U.S. Preventive Services Task Force (https//www.uspreventiveservicestaskforce.org/uspstf/about‑uspstf/methods‑and‑processes/grade‑definitions). At the annual congress of CCI (congress president: Dr. Gao-Jun Teng) held on July 15–18, 2021 in Nanjing, China, a seminar to discuss and evaluate the proposed definition was held on July 17. A total of 31 physicians with senior professional titles who had been engaged in the treatment of HCC for more than 15 years participated in the seminar. All the participating physicians were from tertiary teaching hospitals in China, and the monthly average number of HCC cases treated in their departments was more than 50. They discussed and compared the CCI definition and consensus statement with other existing definitions during the seminar. All the participating physicians agreed that the CCI definition and consensus statement on "TACE refractoriness" had strong rationality and was currently the most suitable "TACE refractoriness" criteria for patients with HCC in China. Recommended Grades According to the US National Clinical Diagnosis and Treatment Guidelines Database Grading System, the evidence is graded [Supplementary Table 1, https://links.lww.com/CM9/B984]. CCI Definition and Consensus Statement on TACE Refractoriness Consensus 1: The CCI TACE refractoriness definition is as follows: After three or more consecutive standardized and precision TACE sessions, the target tumor(s) was still in a progressive disease (PD) state (according to modified Response Evaluation Criteria in Solid Tumors [mRECIST] criteria seen on contrast enhanced computed tomography/magnetic resonance imaging [CT/MRI] at 1-3 months after the latest TACE) compared with that before the first TACE session. Repeated TACE should be terminated after occurrence of TACE refractoriness and other treatments should be considered. Consensus 2: TACE is widely applied for the treatment of unresectable HCC as palliative therapy in clinical practice in China. For patients with a low intrahepatic tumor burden along with uncomplicated tumor blood supply, TACE has the potential to act as a curative approach by superselective embolization (evidence IIb, recommendation B). The global HCC BRIDGE (Bridge to Better Outcomes in HCC) study, a multiregional large-scale longitudinal cohort study including 18,031 patients from 14 countries, has shown that TACE is the most widely used approach for HCC across BCLC stages, especially in intermediate and advanced stages. Differ from the conditions in Western countries and Japan, the majority of HCCs in China have a relatively high tumor burden with the background of hepatitis B virus infection, and therefore, TACE is mainly applied as a palliative approach for HCC in China. Notably, several reported studies have shown that TACE can act as a curative approach by superselective embolization for patients with a low intrahepatic tumor burden and relatively simple blood supply for tumor. Consensus 3: The concept of TACE refractoriness has clinical significance, but it requires rigorous definition and scientific assessment to avoid subjective factors that reduce the actual role of TACE in the treatment of HCC (evidence IIb, recommendation B). As mentioned above, most participants in the survey carried out in 2020 by the CCI agreed that the concept of "TACE refractoriness" has scientific and clinical significance, whereas none of the existing TACE refractoriness definitions were suitable for Chinese HCCs. Blind introduction of existing definitions of "TACE refractoriness" to evaluate the potential benefit of repeated TACE for Chinese HCC patients may lead to a negative long-term prognosis. Consensus 4: Occurrence new intrahepatic lesion(s) post-TACE should not be considered as disease progression, and therefore, it cannot be applied as the criterion for "TACE refractoriness". In such cases, repeated TACE with/without other treatments is recommended (evidence Ib, recommendation A). It is accepted that the occurrence of new intrahepatic lesion(s) is the biological features of HCC and should not be regarded as disease progression[7]. In the TACTICS trial, the occurrence of new intrahepatic lesion(s) was no longer defined as disease progression. Under such conditions, patients could continue to underwent TACE monotherapy or TACE combined with molecular target agents (sorafenib, lenvatinib, donafenib), which was considered as the key reason for the positive results of the trial. Consensus 5: The occurrence of macrovascular invasion and/or extrahepatic metastasis post-TACE should not be applied as the criterion for TACE refractoriness. The concept of TACE refractoriness mainly refers to intrahepatic target lesion(s). Repeated TACE combined with other treatments is recommended even if post-TACE macrovascular invasion and/or extrahepatic metastasis occur while the previous TACE procedure(s) was effective for intrahepatic target lesion(s) (evidence IIb, recommendation B). Several studies have confirmed that patients with macrovascular invasion and/or extrahepatic metastasis post-TACE could still benefit from repeated TACE combined with systemic therapies.[8] For Chinese HCCs with portal vein tumor thrombosis (PVTT), brachytherapy with 125I seed implantation combined with TACE could improve survival benefits. Specifically, for patients with branch PVTT, percutaneous 125I seed or seed strand implantation directly into the portal vein or PVTT should be considered. While for patients with main PVTT, radioactive stents with 125I seed or seed strand placement or helical 125I seed implant should be considered. Consensus 6: At present, any strong and clear evidence has yet to be provided regarding the association between the elevation of HCC-related tumor marker and the occurrence of TACE refractoriness. Further work is warranted to explore such an association (evidence IIb, recommendation B). Several HCC-specific serum tumor markers, such as alpha-fetoprotein (AFP) and Protein Induced by Vitamin K Absence II (PIVKA-Ⅱ), have been widely applied in early diagnosis and prognostic prediction in clinical practice. It has been identified that post-TACE elevation of these markers is an independent risk factor for disease progression for patients treated with TACE. Whereas, the values on changes in serum biomarkers for assessment of tumor response are under investigation and several studies found that patients could still benefit from repeat TACE even with post-TACE elevation of serum tumor markers. Consensus 7: The TACE procedure must be performed with standardization and precision (evidence IIb, recommendation A). Standardization of TACE in clinical practice is difficult to achieve despite the wide application of TACE. The concept of precision TACE has been introduced with the aim of maximizing the standardization of TACE. Precision TACE incorporates careful pretreatment preparation, patients' specific condition, accurate implementation, close follow-up, and whole-process management. Consensus 8: Considering that Chinese HCCs are initially diagnosed with high tumor burden, the "six-and-twelve" score is more suitable for prognostic stratification of intermediate HCCs in China than other models such as up-to-seven criteria (evidence IIb, recommendation B). As mentioned above, Chinese HCCs treated with TACE generally have a higher tumor burden accompanying with chronic liver diseases. Therefore, whether the tumor burden classification criteria, such as the up-to-seven criteria that are mainly widely applied in Western countries and Japan, are still suitable for Chinese HCC remains to be discussed. The six-and-twelve score, which was established based on cohorts from China, is more suitable for prognostic stratification of TACE for Chinese HCCs. Consensus 9: Apart from TACE refractoriness, the concept of TACE unsuitable that indicates termination of repeated TACE should also be emphasized. TACE unsuitable is defined as any of the following conditions: (1) unable to perform catheterization due to occlusion of the feeding arteries; (2) severe decompensated liver function (Child–Pugh C, severe jaundice, overt hepatic encephalopathy, refractory ascites, hepatorenal syndrome); (3) performance status score >2; or (4) diffuse hepatic artery-portal vein/hepatic vein fistula. Repeated TACE should also not be considered for patients meet TACE unsuitable (evidence IIb, recommendation A). Tumor response assessment and treatment strategy after three or more consecutive TACE sessions According to the CCI definition of TACE refractoriness, the Collaboration Group divided the tumor response after three or more consecutive TACE sessions into two groups: TACE refractoriness and TACE effectiveness. In addition, a new algorithm for TACE is proposed with the aim of improving its fit for HCC in China [Figure 1].Figure 1: The algorithm decision tree and evaluation strategy for conventional TACE after three or more consecutive TACEs. aIntrahepatic target lesion(s) including tumor(s) at diagnosis and new intrahepatic tumor(s) emerging after 1st or 2nd TACE treatment; bAdditional therapy and cother therapy including systematic therapy (molecular targeted agent and immune checkpoint inhibitor), locoregional therapy (drug-eluting beads TACE, hepatic artery infusion chemotherapy, selective internal radiation therapy, targeting-intratumoral-lactic-acidosis TACE, ablation therapy, helical Iodine-125 [125I] seed implant, 125I seed or seed strand implantation and 125I irradiation stent) and combined therapy. CR: Complete response; EHS: Extrahepatic metastasis; HCC: Hepatocellular carcinoma; PD: Progression disease; PR: Partial response; PVTT: Portal vein tumor thrombosis; SD: Stable disease; TACE: Transarterial chemoembolization.

Supplementary Materials and Methods

Legends for Supplementary Figures S1-S8.

Correlation of USP4 expression with patients' clinicopathological variables in 167 cases of CRC (S1); Human USP4 shRNA target sequences (S2); Human USP4 and PRL-3 siRNA target sequences (S3); Primers for qPCR (S4).

The degree of RARγ depletion in CRC cells (S1);Knockdown of RARγ enhances CRC cell proliferation (S2); Overexpression of RARγ inhibits CRC growth and metastasis in vitro and in vivo(S3); Cytoplasmic RARγ colocalizes with Yap in CRC cells (S4).

Expression of USP4 in CRC cell lines (S1); Knockdown of USP4 impairs CRC cell proliferation (S2); The degree of USP4 depletion in tumors (S3); Depletion of USP4 inhibits pulmonary metastasis in nude mice (S4); PRL-3 is indispensable for the oncogenic functions of USP4 (S5); USP4 does not affect PRL-3 mRNA expression (S6); Expression of USP4 does not Correlate with PRL-3 mRNA Levels (S7); USP4 protein levels is positively correlated with PRL-3 protein levels in xenografts (S8).

<p>Correlation of RARγ expression with patients' clinicopathological variables in 91 cases of CRC (S1); Human RARγ shRNA target sequences (S2); Primers for qPCR (S3).</p>

Legends for Supplementary Figures S1-S4

目的 评估肝动脉灌注化疗(HAIC)序贯肝动脉栓塞术(TAE)治疗不可切除肝细胞癌的安全性及有效性.方法 收集 2020 年 4 月至 2021 年 4 月采用HAIC序贯TAE治疗的 25 例肝癌患者的临床资料,以ALBI评分评估患者肝功能变化情况,记录术后出现的不良反应.根据改良实体瘤疗效评价标准(mRECIST)评估肿瘤客观缓解率(ORR)、疾病控制率(DCR),并随访患者的疾病进展时间(TTP)和生存时间(OS).结果 患者首次治疗后 3 个月ALBI评分(-2.29±0.53)与术前(-2.32±0.44)相比,差异无统计学意义(t=-0.223,P=0.825).主要不良反应包括肝功能损伤、骨髓抑制、腹痛、恶心呕吐、发热等,4 例患者出现Ⅲ级不良反应(3 例ALT升高,1 例骨髓抑制),其余均为Ⅰ～Ⅱ级不良反应.术后 6 周ORR、DCR分别为 68％、92％,术后 12 周ORR、DCR分别为 72％、88％,中位TTP为 271 d(95％CI:115.9～426.0),中位OS为 510 d(95％CI:491.5～528.5).结论 HAIC序贯TAE治疗不可切除肝癌临床疗效显著,具有良好的耐受性,是安全可行的.

Multi-session transarterial chemoembolization (TACE) is usually needed for the treatment of intermediate-stage hepatocellular carcinoma (HCC), but it may not always have a positive influence on prognosis due to high heterogeneity of HCC. To avoid ineffective repeated TACE, the concept of TACE failure/refractoriness has been proposed by several organizations and is being addressed using tyrosine kinase inhibitors. The concept of TACE failure/refractoriness is controversial due to ambiguous definitions and low evidence-based data. To date, only a few studies have examined the rationality concerning the definition of TACE failure/refractoriness, although the concept has been introduced and applied in many TACE-related clinical trials. This review focuses on some of the issues related to different versions of TACE failure/refractoriness, the rationality of related definitions, and the feasibility of continuing TACE after so-called failure/refractoriness based on published evidence. A suggestion to re-define TAEC failure/refractoriness is also put forward.

Multi-session transarterial chemoembolization (TACE) is usually needed for the treatment of intermediate-stage hepatocellular carcinoma (HCC), but it may not always have a positive influence on prognosis due to high heterogeneity of HCC. To avoid ineffective repeated TACE, the concept of TACE failure/refractoriness has been proposed by several organizations and is being addressed using tyrosine kinase inhibitors. The concept of TACE failure/refractoriness is controversial due to ambiguous definitions and low evidence-based data. To date, only a few studies have examined the rationality concerning the definition of TACE failure/refractoriness, although the concept has been introduced and applied in many TACE-related clinical trials. This review focuses on some of the issues related to different versions of TACE failure/refractoriness, the rationality of related definitions, and the feasibility of continuing TACE after so-called failure/refractoriness based on published evidence. A suggestion to re-define TAEC failure/refractoriness is also put forward.

Transarterial chemoembolization (TACE) is widely applied for the treatment of hepatocellular carcinoma. Repeat TACE is often required in clinical practice because a satisfactory tumor response may not be achieved with a single session. However, repeated TACE procedures can impair liver function and increase treatment-related adverse events, all of which prompted the introduction of the concept of "TACE failure/refractoriness". Mainly based on evidence from two retrospective studies conducted in Japan, sorafenib is recommended as the first choice for subsequent treatment after TACE failure/refractoriness. Several studies have investigated the outcomes of other subsequent treatments, including locoregional, other molecular targeted, anti-programmed death-1/anti-programed death ligand-1 therapies, and combination therapies after TACE failure/refractoriness. In this review, we summarize the up-to-date information about the outcomes of several subsequent treatment modalities after TACE failure/refractoriness.

BACKGROUND AND AIMS:The recognition of transarterial chemoembolization (TACE) failure/refractoriness among Chinese clinicians remains unclear. Using an online survey conducted by the Chinese College of Interventionalists (CCI), the aim of this study was to explore the recognition of TACE failure/refractoriness and review TACE application for hepatocellular carcinoma (HCC) treatment in clinical practice. METHODS:From 27 August 2020 to 30 August 2020 during the CCI 2020 annual meeting, a survey with 34 questions was sent by email to 264 CCI clinicians in China with more than 10 years of experience using TACE for HCC treatment. RESULTS:A total of 257 clinicians participated and responded to the survey. Most participants agreed that the concept of "TACE failure/refractoriness" has scientific and clinical significance (n=191, 74.3%). Nearly half of these participants chose TACE-based combination treatment as subsequent therapy after so-called TACE failure/refractoriness (n=88, 46.1%). None of the existing TACE failure/refractoriness definitions were widely accepted by the participants; thus, it is necessary to re-define this concept for the treatment of HCC in China (n=235, 91.4%). Most participants agreed that continuing TACE should be performed for patients with preserved liver function, presenting portal vein tumor thrombosis (n=242, 94.2%) or extrahepatic spread (n=253, 98.4%), after the previous TACE treatment to control intrahepatic lesion(s). CONCLUSIONS:There is an obvious difference in the recognition of TACE failure/refractoriness among Chinese clinicians based on existing definitions. Further work should be carried out to re-define TACE failure/refractoriness.

BACKGROUND. Drug-eluting bead transarterial chemoembolization (DEB-TACE) has emerged as an alternative to conventional TACE (cTACE) for treatment of hepatocellular carcinoma (HCC), although selection between the approaches remains controversial. OBJECTIVE. The purpose of this study was to compare DEB-TACE and cTACE in the treatment of patients with unresectable HCC in terms of hepatobiliary changes on imaging and clinical complications. METHODS. This retrospective study included 1002 patients (871 men, 131 women; mean age, 59 +/- 12 years) from three centers who had previously untreated unresectable HCC and underwent DEB TACE with epirubicin (780 procedures in 394 patients) or cTACE with ethiodized oil mixed with doxorubicin and oxaliplatin (1187 procedures in 608 patients) between May 2016 and November 2018. Among these patients 83.4% had hepatitis B-related liver disease, 57.6% had Barcelona Clinic Liver Cancer (BCLC) stage A or B HCC, and 42.4% had three or more nodules. Mean tumor size was 6.3 +/- 4.2 cm. Hepatobiliary changes and tumor response were evaluated with CT or MRI 1 month after TACE. Clinical records were reviewed for adverse events. RESULTS. Bile duct dilatation (p <.001) and portal vein narrowing (p =.006) on imaging and liver failure (p = .03) and grade 3 abdominal pain (p < .001) in clinical follow-up occurred at higher frequency in the DEB-TACE group (15.5%, 4.6%, 2.3%, and 6.1%) than in the cTACE (7A%, 1.6%, 0.7%, and 2.1%) group. Higher frequency of bile duct dilation in patients who underwent DEB TACE was observed in subgroup analyses that included patients with BCLC stage A or B HCC (p = .001), with cirrhosis (p < .001), without cirrhosis (p = .04), and without main portal vein tumor thrombus (p = .002). Total bilirubin level 1 month after treatment was 1.5 +/- 2.4 mg/dL (95% CI, 1.2-1.8 mg/dL) for DEB TACE versus 1.3 +/- 2.0 mg/dL (95% CI, 1.1-1.5 mg/dL) for cTACE (p = .02). The cTACE and DEB TACE groups did not differ in other manifestations of postembolization syndrome or systemic toxicity (p > .05). Local tumor disease control rates did not differ between the cTACE and DEB-TACE groups (1 month, 96.7% vs 98.5%, p = .06; 3 months, 81.8% vs 82.4%, p .87), but overall DCR was significantly higher in the cTACE than in the DEB-TACE group (1 month, 87.5% vs 80.0%, p = .001; 3 months, 78.5% vs 72.1%, p = .02). CONCLUSION. Compared with cTACE, DEB TACE was associated with greater frequency of hepatobiliary injury and severe abdominal pain. CLINICAL IMPACT. Greater caution and closer follow-up are warranted for patients who undergo DEB-TACE for unresectable HCC than for those who undergo cTACE.

目的 探究进展期肝癌患者接受TACE治疗后生存获益的影响因素,进而对筛选合适治疗人群提供参考.方法 回顾性分析2016年3月至2019年3月在本中心行TACE治疗的进展期肝癌患者.患者病程中只接受过TACE治疗.统计每例患者基线特征、病灶特征以及首次TACE术前相关实验室检查指标.评估首次TACE术后反应.研究终点为患者总体生存期.采用Cox风险回归模型多因素分析得出影响患者累积生存率的独立影响因素.结果 本研究共纳入87例患者,72例(82.8％)既往乙型肝炎病史,中位生存期为7.4个月.多因素分析得出5个独立影响因素:最大病灶直径(风险比HR=5.689,95％CI:2.366,13.681)、门静脉癌栓分级(HR=1.937,95％CI:1.129,3.324)、血清白蛋白(HR=2.367,95％CI:1.161,4.827)、凝血酶原时间(HR=2.177,95％CI:1.119,4.238)、mRECIST分级(HR=5.076,95％CI:2.391,10.776).5个因素对生存期的影响差异均有统计学意义.结论 最大病灶直径≥7 cm,门静脉癌栓累积一级分支或主干,血清白蛋白、凝血酶原时间指标异常的进展期肝癌患者在TACE治疗中很大可能无法生存获益.首次TACE术后病灶反应情况对于生存期有一定的预测作用.

[This corrects the article DOI: 10.3389/fmolb.2021.624366.].

目的 观察由卧位至立位经颈内静脉植入胸壁式输液港导管头端位置变化,并分析其影响因素.方法 回顾性分析171例接受颈内静脉植入胸壁港患者,均于术后拍摄卧位和立位X线胸片,测量由卧位至立位时导管头端移动距离,采用Pearson相关分析及多元回归分析观察导管头端移动距离的影响因素.结果 由卧位至立位时导管头端呈向头侧移位倾向,平均移动距离(15.82±16.87)mm.导管头端移动距离与性别(P=0.039)及皮脂厚度(P=0.011)呈正相关,与留置导管长度(P=0.039)呈负相关.结论 由卧位至立位时,经颈内静脉植入胸壁式输液港导管头端倾向于向头侧移位,移动距离与患者性别、皮脂厚度及留置导管长度相关.