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Improved Local Tumor Control and Survival Rates by Obtaining a 3D-Safety Margin in Superselective Transarterial Chemoembolization for Small Hepatocellular Carcinoma

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Objective

To investigate technical factors affecting local tumor control of small hepatocellular carcinoma (HCC) treated by superselective conventional transarterial chemoembolization (cTACE) using lipiodol and to compare prognoses between groups with and without these factors.

Materials and Methods

Sixty-three consecutive patients with 73 HCC nodules (diameter, 1–3 cm) treated by cTACE were retrospectively analyzed. A positive or a negative 3D-safety margin was defined as a ≥ 1-mm area of lipiodol accumulation or as a diameter of lipiodol accumulation < 1 mm in liver parenchyma surrounding the tumor using plain CT images obtained within a week after TACE. Uni- and multivariate analyses were performed to identify technical factors determining local tumor control rate. Subgroup analysis of survival rates in treatment-naïve patients was performed according to the detected factors.

Results

In univariate analyses, three-dimensional (3D)-safety margin and portal vein visualization were associated with local tumor control rates. In multivariate analysis, only positive 3D-safety margin remained a significant contributor (p = 0.001). Two-year cumulative local disease-free survival rates with positive and negative 3D-safety margin were 82.8% and 19.3%, respectively (p = 0.001). In subgroup survival analysis of the 36 newly diagnosed patients, the 1-, 2-, 3-, 4-, and 5-year cumulative OS rates for patients with and without positive margins were 100% versus 100%, 96.4% versus 75.0%, 81.8% versus 62.5%, 74.4% versus 41.7%, and 47.0% versus 0%, respectively (median survival time; 57.6 months vs. 37.1, p = 0.047).

Conclusion

Obtaining a 3D-safety margin can suppress local tumor recurrence and prolong survival in superselective cTACE for small HCC.

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Abbreviations

HCC:

Hepatocellular carcinoma

cTACE:

Conventional transarterial chemoembolization

TACE:

Transarterial chemoembolization

RFA:

Radiofrequency ablation

3D:

Three dimensional

CT:

Computed tomography

MRI:

Magnetic resonance imaging

MPR:

Multi-planar reconstruction

DFS:

Local disease-free survival

OS:

Overall survival

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

T-Bil:

Total bilirubin

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Authors and Affiliations

  1. Department of Radiology and IVR Center, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Thailand

    Thanate Kattipatanapong, Hideyuki Nishiofuku, Toshihiro Tanaka, Takeshi Sato, Tetsuya Masada, Shota Tatsumoto, Takeshi Matsumoto & Kimihiko Kichikawa

  2. Department of Radiology, Chiang Mai University, Chiang Mai, Thailand

    Thanate Kattipatanapong

Authors
  1. Thanate Kattipatanapong
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  2. Hideyuki Nishiofuku
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  3. Toshihiro Tanaka
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  4. Takeshi Sato
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  5. Tetsuya Masada
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Correspondence to Hideyuki Nishiofuku.

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Conflict of interest

The scientific guarantor of this publication is Prof. Kichikawa in Nara Medical University. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all patients in this study. Methodology: This paper is retrospective study at single institution. UMIN ID; R000029341.

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Kattipatanapong, T., Nishiofuku, H., Tanaka, T. et al. Improved Local Tumor Control and Survival Rates by Obtaining a 3D-Safety Margin in Superselective Transarterial Chemoembolization for Small Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 43, 423–433 (2020). https://doi.org/10.1007/s00270-019-02365-9

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