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Comparison of local recurrence in transcatheter arterial chemoembolization of hepatocellular carcinoma with or without accumulation of iodized oil beyond corona enhancement area: Short-term results

Yukinobu Watanabe
Yukinobu Watanabe
, 
Masahiro Ogawa
Masahiro Ogawa
, 
Masahiro Kaneko
Masahiro Kaneko
, 
Mariko Kumagawa
Mariko Kumagawa
, 
Midori Hirayama
Midori Hirayama
, 
Naoki Matsumoto
Naoki Matsumoto
, 
Hiroshi Nakagawara
Hiroshi Nakagawara
, 
Toshiki Yamamoto
Toshiki Yamamoto
 and 
Mitsuhiko Moriyama
Mitsuhiko Moriyama
   | Dec 22, 2021
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Article Category: Research Article
Published Online: Dec 22, 2021
Page range: 69 - 75
Received: Aug 12, 2021
Accepted: Oct 01, 2021
DOI: https://doi.org/10.2478/raon-2021-0047
© 2022 Yukinobu Watanabe, Masahiro Ogawa, Masahiro Kaneko, Mariko Kumagawa, Midori Hirayama, Naoki Matsumoto, Hiroshi Nakagawara, Toshiki Yamamoto, Mitsuhiko Moriyama, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Flow diagram of patients’ and nodules’ selection. CTHA = computed tomography during hepatic arteriography; DEB-TACE = drug-eluting beads transcatheter arterial chemoembolization; RFA = radiofrequency ablation; TACE = transcatheter arterial chemoembolization
Flow diagram of patients’ and nodules’ selection. CTHA = computed tomography during hepatic arteriography; DEB-TACE = drug-eluting beads transcatheter arterial chemoembolization; RFA = radiofrequency ablation; TACE = transcatheter arterial chemoembolization

Figure 2

Local tumor recurrence after transcatheter arterial chemoembolization (TACE) in an 82-year-old patient with a hepatocellular carcinoma. (A) Early-phase computed tomography during hepatic arteriography (CTHA) demonstrated a hypervascular nodule in S5. (B) Late-phase CTHA demonstrated the corona enhancement around the tumor (white arrow). (C) Non-contrast-enhanced computed tomography performed immediately after TACE showed dense accumulation of iodized oil throughout the tumor, but not in the entire corona enhancement area. (D) In contrast enhanced magnetic resonance images obtained 4 months after TACE, local recurrence developed around the tumor (black arrow).
Local tumor recurrence after transcatheter arterial chemoembolization (TACE) in an 82-year-old patient with a hepatocellular carcinoma. (A) Early-phase computed tomography during hepatic arteriography (CTHA) demonstrated a hypervascular nodule in S5. (B) Late-phase CTHA demonstrated the corona enhancement around the tumor (white arrow). (C) Non-contrast-enhanced computed tomography performed immediately after TACE showed dense accumulation of iodized oil throughout the tumor, but not in the entire corona enhancement area. (D) In contrast enhanced magnetic resonance images obtained 4 months after TACE, local recurrence developed around the tumor (black arrow).

Figure 3

Complete response after transcatheter arterial chemoembolization (TACE) in a 77-year-old patient with a hepatocellular carcinoma. (A) Early-phase computed tomography during hepatic arteriography (CTHA) demonstrated a hypervacular nodule in S4. (B) Late-phase CTHA demonstrated the corona enhancement around the tumor (white arrow). (C) Non-contrast-enhanced computed tomography performed immediately after TACE showed dense accumulation of iodized oil beyond corona enhancement area. (D) Contrast-enhanced computed tomography performed 15 months after TACE showed no enhancement around the tumor.
Complete response after transcatheter arterial chemoembolization (TACE) in a 77-year-old patient with a hepatocellular carcinoma. (A) Early-phase computed tomography during hepatic arteriography (CTHA) demonstrated a hypervacular nodule in S4. (B) Late-phase CTHA demonstrated the corona enhancement around the tumor (white arrow). (C) Non-contrast-enhanced computed tomography performed immediately after TACE showed dense accumulation of iodized oil beyond corona enhancement area. (D) Contrast-enhanced computed tomography performed 15 months after TACE showed no enhancement around the tumor.

Figure 4

Local tumor recurrence-free rate according to the range of the embolization for transcatheter arterial chemoembolization (TACE). The cumulative 3-, 6-, 12-month tumor local recurrence rates were 2.8%, 2.8%, 8.3%, respectively, for cases with embolization of the entire corona enhancement area, and 20.8%, 45.8%, 75%, respectively, for cases without embolization of the entire corona enhancement area (hazard ratio [HR], 0.079; 95% confidence interval [CI], 0.026–0.24; p < 0.001).
Local tumor recurrence-free rate according to the range of the embolization for transcatheter arterial chemoembolization (TACE). The cumulative 3-, 6-, 12-month tumor local recurrence rates were 2.8%, 2.8%, 8.3%, respectively, for cases with embolization of the entire corona enhancement area, and 20.8%, 45.8%, 75%, respectively, for cases without embolization of the entire corona enhancement area (hazard ratio [HR], 0.079; 95% confidence interval [CI], 0.026–0.24; p < 0.001).

Clinical characteristics of nodules in group A and B

Clinical characteristics Group A (n = 36) Group B (n = 24) p value
Age, years* 74 (70–79) 71 (64–79) 0.149
Gender, male/female 8/28 6/18 0.999
Etiology (HCV/HBV/Alcohol/Unknown) 16/8/8/4 9/5/6/4 0.912
Child-Pugh classification (A/B) 31/5 19/5 0.569
BCLC stage(0/A/B) 11/20/5 5/17/2 0.545
Size of tumor, mm* 14.5 (12–21.3) 15.5 (11–22) 0.757
Thickness of corona enhancement(≤ 2mm/>2mm) 17/19 10/14 0.793
AFP, ng/ml* 4.9 (2.6–10.6) 5.9 (2.7–14.1) 0.419
DCP, mAU/mL* 26.4 (17.0–49.2) 48.8 (25.3–153.9) 0.021
Usage of miriplatin, mg* 28 (20–38.5) 30 (22.4–51.5) 0.310

Univariate and multivariate logistic regression analysis for factor affecting local tumor recurrence

Factor Univariate analysis
 Multivariate analysis
Odds ratio (95% CI) p value Odds ratio (95% CI) p value
Size of tumor (< 20 vs. ≥ 20 mm) 0.67 (0.20–2.32) 0.577
AFP (< 10 vs. ≥ 10 ng/mL) 0.45 (0.13–1.61) 0.242
DCP (< 40 vs. ≥ 40 mAU/mL) 0.59 (0.18–1.92) 0.417
Usage of miriplatin (< 30 vs. ≥ 30 mg) 0.70 (0.17–1.89) 0.420
Thickness of corona enhancement (≤ 2mm/ > 2mm) 0.97 (0.30–3.20) 0.999
Degree of iodized oil accumulation (Group A vs. B) 0.045 (0.0080–0.20) < 0.001 0.042 (0.010–0.17) < 0.001
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