Exploratory study of microparticle transcatheter arterial chemoembolization combined with resection for huge hepatocellular carcinoma

To investigate the safety and clinical efficacy of microparticle transcatheter arterial chemoembolization (mTACE) combined with surgical resection for the treatment of huge hepatocellular carcinoma (hHCC; ≥ 10 ​cm).

A retrospective descriptive study was conducted to gather the clinical data of nine patients with hHCCs treated with mTACE combined with resection in Beijing Tsinghua Changgung Hospital from December 2016 to July 2020. The outcome were as follows: (1) the excellent effect and adverse reactions of mTACE and (2) the efficacy and safety of perioperative resection. Count data were expressed as absolute numbers and percentages. The measurement data of the normal distribution is represented by X ​± ​S, and the measurement data of the skewed distribution are represented by M (range). A paired t-test was used to compare the data of the same patient. p values < 0.05 are considered statistically significant.

(1) Regarding the efficacy and safety of mTACE, all nine hHCCs were treated with mTACE one time. The tumor necrosis rate after particle TACE was (77.6 ​± ​15.7)% (51.7%-100%); according to the modified response evaluation criteria in solid tumors, the objective response was partial response in eight patients and complete response in one patient. The alpha fetoprotein (AFP) level was abnormal in six cases (> 20 ​ng/mL), of which three cases exceeded the maximum value (> 30,000 ​ng/mL) pre-mTACE. In six patients with abnormal AFP levels, the AFP level decreased in five patients, with a median percentage of 74.5% (35.2%-96.0%). The PIVKA-II level in nine patients was > 40 ​mAU/mL before mTACE and decreased to varying degrees after mTACE. The median percentage of decline was 76.0% (4.5%-99.8%). The maximum diameter of the tumor decreased from (13.9 ​± ​1.9) cm (11.0-16.4 ​cm) to (12.8 ± 1.9) ​cm (10.4-15.6 ​cm) (P ​= ​0.001) before surgical resection. Prior to the surgical resection, the tumor volume decreased from (897 ​± ​244) mL (436-1250 ​mL) to (750 ​± ​291) mL (260-1130 ​mL) (P ​= ​0.001), and the residual liver volume/standard liver volume increased from (42.8 ​± ​12.8)% (25.8%-61.3%) to (50.2 ​± ​14.9)% (28.8%-67.4%) (P ​= ​0.008). All patients had embolism syndrome such as fever and abdominal pain in varying degrees, and no serious complications such as liver abscess, liver and kidney failure, or ectopic embolism were noted. (2) For perioperative efficacy and safety, all lesions were successfully resected in (31 ​± ​11) days (14-48 days) after mTACE. The operation time was (395 ​± ​79) min (296-540 ​min), and the amount of intraoperative bleeding was (433 ​± ​158) mL (200-600 ​mL). Complications such as biliary fistula, abdominal bleeding, liver and kidney failure, or abdominal infection were not found. The postoperative hospital stay was (13 ​± ​4) days (9-19 days). No tumor invasion was found at the cutting edge, and hepatic vein invasion was observed in one case. (3) The follow-up ended in November 2021, with a median follow-up of 34 months (16-46 months). Recurrence or distant metastasis occurred in four patients, of which two patients died. The survival times were 18 and 31 months, respectively. The other two patients were followed up for 34 and 41 months. The remaining five patients were followed up for 16-46 months without antitumor treatment or disease progression.

mTACE combined with tumor resection is feasible for the treatment of patients with hHCC, which needs to be further confirmed by prospective studies.