Efficacy and safety of drug-eluting beads transarterial chemoembolization in conversion therapy for massive hepatocellular carcinoma

doi:10.3877/cma.j.issn.2095-3232.2026.01.006

Abstract

Abstract:

Objective

To evaluate the efficacy and safety of drug-eluting beads transarterial chemoembolization (DEB-TACE) in the conversion therapy for massive hepatocellular carcinoma (HCC).

Methods

Clinicopathological data of 19 patients with massive HCC receiving conversion therapy of DEB-TACE in the First Affiliated Hospital of Nanjing Medical University from January to December 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among 19 patients, 13 were male and 6 female, aged (63±11) years. The study included 12 patients of China Liver Cancer Staging (CNLC) stage Ⅰb, 4 cases of CNLC stage Ⅱb and 3 cases of CNLC stage Ⅲa. The tumor diameter was (12.1±1.9) cm. Retrospective descriptive and cohort study methods were adopted. Tumor status and general conditions of patients, DEB-TACE, conversion treatment, surgery, and follow-up data and survival in success and failure groups were observed. Kaplan-Meier method and Log-rank test were used for survival analysis.

Results

All 19 patients successfully completed DEB-TACE, with high safety and tolerance. Among them, 6 patients obtained successful conversion treatment (success group), and the success rate of conversion treatment was 32%. 5 patients underwent radical surgery, and 1 patient evaluated as complete remission (CR) refused surgery. The remaining 13 patients were assessed as unsuccessful conversion treatment (68%, failure group), including 9 patients were assessed as stable disease (SD) and 4 as progressive disease (PD). The median overall survival (OS) was not achieved in the success group and 6 months in the failure group, with statistical significance between two groups (χ²=8.054, P=0.005). The median progression-free survival (PFS) was not achieved in the success group and 4 months in the failure group, with statistical significance between two groups (χ²=8.625, P=0.003).

Conclusions

DEB-TACE conversion treatment yields high conversion rate, high safety and tolerance. Successful conversion treatment can significantly prolong PFS and OS. This protocol is worthy of clinical application.

Key words: Carcinoma,hepatocellular, Giant hepatocellular carcinoma, Conversion therapy, Drug eluting bead transarterial chemoembolization (DEB-TACE), Treatment related adverse events

Long Zhang, Wei Xu, Shanke Sun, Wenzhu Li, Junda Li, Yongquan Chi, Jinhua Song, Xuehao Wang, Feng Cheng, Jianhua Rao. Efficacy and safety of drug-eluting beads transarterial chemoembolization in conversion therapy for massive hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(01): 28-35.

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Figures/Tables 6

项目	数据
性别[例(%)]
男	13(68)
女	6(32)
年龄(岁, $x ¯$ ±s)	63±11
治疗前CNLC分期[例(%)]
Ⅰb 期	12(63)
Ⅱb 期	4(21)
Ⅲa 期	3(16)
肿瘤长径(cm, $x ¯$ ±s)	12.1±1.9
AFP ≥400 μg/L[例(%)]	7(37)
PIVKA-Ⅱ阳性[例(%)]	15(79)
CEA[μg/L, M(Q₁, Q₃)]	2.2(1.4, 4.3)
CA19-9[U/L, M(Q₁, Q₃)]	19 (7, 37)
HBsAg阳性[例(%)]	10(53)
HCV阳性[例(%)]	1(5)
ALT[U/L, M(Q₁, Q₃)]	28 (18, 39)
AST[U/L, M(Q₁, Q₃)]	49(39, 54)
TB[μmol/L, M(Q₁, Q₃)]	12.8(11.6, 18.2)
Child-Pugh分级A级[例(%)]	19(100)
ECOG-PS评分0分[例(%)]	14(74)

项目	数据
性别[例(%)]
男	13(68)
女	6(32)
年龄(岁, $x ¯$ ±s)	63±11
治疗前CNLC分期[例(%)]
Ⅰb 期	12(63)
Ⅱb 期	4(21)
Ⅲa 期	3(16)
肿瘤长径(cm, $x ¯$ ±s)	12.1±1.9
AFP ≥400 μg/L[例(%)]	7(37)
PIVKA-Ⅱ阳性[例(%)]	15(79)
CEA[μg/L, M(Q₁, Q₃)]	2.2(1.4, 4.3)
CA19-9[U/L, M(Q₁, Q₃)]	19 (7, 37)
HBsAg阳性[例(%)]	10(53)
HCV阳性[例(%)]	1(5)
ALT[U/L, M(Q₁, Q₃)]	28 (18, 39)
AST[U/L, M(Q₁, Q₃)]	49(39, 54)
TB[μmol/L, M(Q₁, Q₃)]	12.8(11.6, 18.2)
Child-Pugh分级A级[例(%)]	19(100)
ECOG-PS评分0分[例(%)]	14(74)

例序	性别	年龄(岁)	手术时间(min)	术中输血(U)	手术方式	术后住院(d)	病理评价
1	女	64	330	7	开腹	12	PR
2	男	60	108	/	开腹	7	CR
3	女	74	184	/	开腹	10	PR
4	男	66	215	2	开腹	9	PR
5	女	61	129	/	腹腔镜	7	CR

项目	成功组	失败组	P值^a
性别			0.241
男	3	10
女	3	3
年龄(岁)			0.255
≥60	6	9
＜60	0	4
AFP(μg/L)			0.830
≥400	2	5
＜400	4	8
门静脉癌栓			0.200
有	0	3
无	6	10
肝内子灶			0.750
有	1	3
无	5	10
HBsAg			0.350
阳性	2	8
阴性	4	5
联合用药			0.911
有	4	9
无	2	4

References 32

[1]	中华人民共和国国家卫生健康委员会医政司. 原发性肝癌诊疗指南(2024年版)[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(4): 407-449. DOI: 10.3877/cma.j.issn.2095-3232.2024.04.001.
[2]	Fang Q, Xie QS, Chen JM, et al. Long-term outcomes after hepatectomy of huge hepatocellular carcinoma: a single-center experience in China[J]. Hepatobiliary Pancreat Dis Int, 2019, 18(6): 532-537. DOI: 10.1016/j.hbpd.2019.09.001.
[3]	Elhanafy E, Aboelinin M, Said R, et al. Outcomes of liver resection for huge hepatocellular carcinoma exceeding 10 cm in size: a single center experience[J]. Am J Surg, 2023, 225(6): 1013-1021. DOI: 10.1016/j.amjsurg.2022.12.005.
[4]	Yang L, Xu J, Ou D, et al. Hepatectomy for huge hepatocellular carcinoma: single institute's experience[J]. World J Surg, 2013, 37(9): 2189-2196. DOI: 10.1007/s00268-013-2095-5.
[5]	Yang J, Li C, Wen TF, et al. Is hepatectomy for huge hepatocellular carcinoma (≥10 cm in diameter) safe and effective? A single-center experience[J]. Asian Pac J Cancer Prev, 2014, 15(17): 7069-7077. DOI: 10.7314/apjcp.2014.15.17.7069.
[6]	中国医疗保健国际交流促进会肝脏肿瘤学分会, 中国抗癌协会肝癌专业委员会, 中国医师协会肝癌专业委员会, 等. 肝细胞癌新辅助及转化治疗中国专家共识(2023版)[J/CD]. 肝癌电子杂志, 2023, 10(4): 1-14.
[7]	Duan X, Liu J, Han X, et al. Comparison of treatment response, survival profiles, as well as safety profiles between CalliSpheres^® microsphere transarterial chemoembolization and conventional transarterial chemoembolization in huge hepatocellular carcinoma[J]. Front Oncol, 2022, 11: 793581. DOI: 10.3389/fonc.2021.793581.
[8]	National Cancer Institute. Common in terminology criteria for adverse events(CTCAE)[EB/OL]. (2018-03-11)[2019-09-04].
[9]	Cai X, Wu S. Transarterial chemoembolization versus surgical resection for giant hepatocellular carcinoma under the different status of capsule: a retrospective study[J]. Transl Cancer Res, 2022, 11(12): 4359-4372. DOI: 10.21037/tcr-22-2473.
[10]	Bogdanovic A, Bulajic P, Masulovic D, et al. Liver resection versus transarterial chemoembolization for huge hepatocellular carcinoma: a propensity score matched analysis[J]. Sci Rep, 2021, 11(1): 4493. DOI: 10.1038/s41598-021-83868-9.
[11]	Chen XP, Qiu FZ, Wu ZD, et al. Hepatectomy for huge hepatocellular carcinoma in 634 cases[J]. World J Gastroenterol, 2006, 12(29): 4652-4655. DOI: 10.3748/wjg.v12.i29.4652.
[12]	Hwang S, Lee YJ, Kim KH, et al. Long-term outcome after resection of huge hepatocellular carcinoma ≥10 cm: single-institution experience with 471 patients[J]. World J Surg, 2015, 39(10): 2519-2528. DOI: 10.1007/s00268-015-3129-y.
[13]	Zhong NB, Lv GM, Chen ZH. Stereotactic body radiotherapy combined with transarterial chemoembolization for huge (≥10 cm) hepatocellular carcinomas: a clinical study[J]. Mol Clin Oncol, 2014, 2(5): 839-844. DOI: 10.3892/mco.2014.304.
[14]	He M, Li Q, Zou R, et al. Sorafenib plus hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin vs sorafenib alone for hepatocellular carcinoma with portal vein invasion: a randomized clinical trial[J]. JAMA Oncol, 2019, 5(7): 953-960. DOI: 10.1001/jamaoncol.2019.0250.
[15]	He MK, Zou RH, Li QJ, et al. Phase Ⅱ study of sorafenib combined with concurrent hepatic arterial infusion of oxaliplatin, 5-fluorouracil and leucovorin for unresectable hepatocellular carcinoma with major portal vein thrombosis[J]. Cardiovasc Intervent Radiol, 2018, 41(5): 734-743. DOI: 10.1007/s00270-017-1874-z.
[16]	Zhang J, Zhang X, Mu H, et al. Surgical conversion for initially unresectable locally advanced hepatocellular carcinoma using a triple combination of angiogenesis inhibitors, anti-PD-1 antibodies, and hepatic arterial infusion chemotherapy: a retrospective study[J]. Front Oncol, 2021, 11: 729764. DOI: 10.3389/fonc.2021.729764.
[17]	He MK, Liang RB, Zhao Y, et al. Lenvatinib, toripalimab, plus hepatic arterial infusion chemotherapy versus lenvatinib alone for advanced hepatocellular carcinoma[J]. Ther Adv Med Oncol, 2021, 13: 17588359211002720. DOI: 10.1177/17588359211002720.
[18]	Gan L, Lang M, Tian X, et al. A retrospective analysis of conversion therapy with lenvatinib, sintilimab, and arterially-directed therapy in patients with initially unresectable hepatocellular carcinoma[J]. J Hepatocell Carcinoma, 2023, 10: 673-686. DOI: 10.2147/JHC.S404675.
[19]	Zhang Y, Huang G, Wang Y, et al. Is salvage liver resection necessary for initially unresectable hepatocellular carcinoma patients downstaged by transarterial chemoembolization? Ten years of experience[J]. Oncologist, 2016, 21(12): 1442-1449. DOI: 10.1634/theoncologist.2016-0094.
[20]	Wu B, Zhou J, Ling G, et al. CalliSpheres drug-eluting beads versus lipiodol transarterial chemoembolization in the treatment of hepatocellular carcinoma: a short-term efficacy and safety study[J]. World J Surg Oncol, 2018, 16(1): 69. DOI: 10.1186/s12957-018-1368-8.
[21]	Duan X, Li H, Chen P, et al. Transcatheter arterial chemoembolization using CalliSpheres beads loaded with arsenic trioxide for unresectable large or huge hepatocellular carcinoma: a prospective study[J]. Eur Radiol, 2024, 34(2): 1258-1267. DOI: 10.1007/s00330-023-10097-1.
[22]	Wang Z, Mu K, Lv Y, et al. Efficacy, safety, and prognostic factors of drug-eluting beads transarterial chemoembolization using CalliSpheres in treating huge hepatocellular carcinoma patients[J]. Ir J Med Sci, 2022, 191(6): 2493-2499. DOI: 10.1007/s11845-021-02851-5.
[23]	Lyu N, Lin Y, Kong Y, et al. FOXAI: a phase Ⅱ trial evaluating the efficacy and safety of hepatic arterial infusion of oxaliplatin plus fluorouracil/leucovorin for advanced hepatocellular carcinoma[J]. Gut, 2018, 67(2): 395-396. DOI: 10.1136/gutjnl-2017-314138.
[24]	Sun L, Hu Z, Xie W, et al. Sequential vs. concurrent systemic therapies in combination with FOLFOX-HAIC for locally advanced hepatocellular carcinoma: a single-center, real-world cohort study[J]. BMC Cancer, 2024, 24(1): 1168. DOI: 10.1186/s12885-024-12940-0.
[25]	Li S, Lyu N, Han X, et al. Hepatic artery infusion chemotherapy using fluorouracil, leucovorin, and oxaliplatin versus transarterial chemoembolization as initial treatment for locally advanced hepatocellular carcinoma: a propensity score-matching analysis[J]. J Vasc Interv Radiol, 2021, 32(9): 1267-1276. e1. DOI: 10.1016/j.jvir.2021.06.008.
[26]	Zuo M, Cao Y, Yang Y, et al. Hepatic arterial infusion chemotherapy plus camrelizumab and apatinib for advanced hepatocellular carcinoma[J]. Hepatol Int, 2024, 18(5): 1486-1498. DOI: 10.1007/s12072-024-10690-6.
[27]	Zhang TQ, Geng ZJ, Zuo MX, et al. Camrelizumab (a PD-1 inhibitor) plus apatinib (an VEGFR-2 inhibitor) and hepatic artery infusion chemotherapy for hepatocellular carcinoma in Barcelona Clinic Liver Cancer stage C (TRIPLET): a phase Ⅱ study[J]. Signal Transduct Target Ther, 2023, 8(1): 413. DOI: 10.1038/s41392-023-01663-6.
[28]	Deng M, Zhong C, Li D, et al. Hepatic arterial infusion chemotherapy-based conversion hepatectomy in responders versus nonresponders with hepatocellular carcinoma: a multicenter cohort study[J]. Int J Surg, 2025, 111(1): 135-145. DOI: 10.1097/JS9.0000000000002043.
[29]	Wang J, Zheng Z, Wu T, et al. Hepatic arterial infusion chemotherapy as a timing strategy for conversion surgery to treat hepatocellular carcinoma: a single-center real-world study[J]. J Hepatocell Carcinoma, 2022, 9: 999-1010. DOI: 10.2147/JHC.S379326.
[30]	Lencioni R, Llovet JM, Han G, et al. Sorafenib or placebo plus TACE with doxorubicin-eluting beads for intermediate stage HCC: The SPACE trial[J]. J Hepatol, 2016, 64(5): 1090-1098. DOI: 10.1016/j.jhep.2016.01.012.
[31]	Llovet JM, Kudo M, Merle P, et al. Lenvatinib plus pembrolizumab versus lenvatinib plus placebo for advanced hepatocellular carcinoma (LEAP-002): a randomised, double-blind, phase 3 trial[J]. Lancet Oncol, 2023, 24(12): 1399-1410. DOI: 10.1016/S1470-2045(23)00469-2.
[32]	Qin S, Chen M, Cheng AL, et al. Atezolizumab plus bevacizumab versus active surveillance in patients with resected or ablated high-risk hepatocellular carcinoma (IMbrave050): a randomised, open-label, multicentre, phase 3 trial[J]. Lancet, 2023, 402(10415): 1835-1847. DOI: 10.1016/S0140-6736(23)01796-8.

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