Abstract No. 517 Conventional vs. drug-eluting beads TACE for hepatocellular carcinoma: a propensity score–weighted comparison

Abstract

Purpose: The purpose of this study was to compare the efficacy and safety of conventional transarterial chemoembolization (cTACE) with drug-eluting beads (DEB)-TACE in patients with hepatocellular carcinoma (HCC) without portal venous thrombosis (PVT). Materials: This retrospective analysis included a total of 370 patients with HCC, who were treated with either cTACE (N ¼ 248) or DEB-TACE (N ¼ 122) between 2000 and 2014. Clinical and biochemical toxicities of Grade 3 (CTAEv4) were recorded for all patients. Survival analysis was conducted using uni-and multivariate Cox proportional hazards models and Kaplan-Meier analysis using log-rank test and propensity score weighting via a generalized boosted model. In addition, sub-group analysis was performed to compare survival after cTACE and DEB-TACE stratified according to tumor size (>3 cm or >5 cm) and tumor morphology (infiltrative vs. nodular) on baseline imaging. Results: There was no significant difference in the prevalence of adverse events except for abdominal pain/discomfort which occurred more frequently after DEB-TACE (87.1%) than after cTACE (75.1%, p ¼ .02). The median overall survival (MOS) of the entire cohort was 28.1 mo. There was no significant difference in MOS between cTACE (19.5 mo) and DEB-TACE (22.2 mo) patients after propensity score weighing (p ¼ .405). However, in patients with infiltrative disease, cTACE achieved significantly longer MOS (12.1 mo) compared to DEB-TACE (8.6 mo; p ¼ .033). Conversely, in patients with nodular disease, DEB-TACE patients (25.4 mo) demonstrated significantly greater survival compared to cTACE patients (23.5 mo; p ¼ .023). Stratification according to tumor size did not achieve a significant separation of survival curves.Conclusions: This study did not demonstrate a significant difference in efficacy and toxicity between cTACE and DEB-TACE for the treatment of HCC without PVT. However, subgroup analysis of the cohort revealed that cTACE showed superior efficacy in patients with infiltrative disease whereas DEB-TACE was more effective in nodular tumors. Thus, tumor morphology and distribution on baseline imaging should be used as a parameter to inform decisions on the selection of embolic materials for TACE.