Open Access

CT-guided 125I brachytherapy for hepatocellular carcinoma in high-risk locations after transarterial chemoembolization combined with microwave ablation: a propensity score-matched study

Zixiong Chen
Zixiong Chen
, 
Xiaobo Fu
Xiaobo Fu
, 
Zhenkang Qiu
Zhenkang Qiu
, 
Maoyuan Mu
Maoyuan Mu
, 
Weiwei Jiang
Weiwei Jiang
, 
Guisong Wang
Guisong Wang
, 
Zhihui Zhong
Zhihui Zhong
, 
Han Qi
Han Qi
 and 
Fei Gao
Fei Gao
   | Mar 22, 2023
Radiology and Oncology's Cover Image
About this article
Previous Article
Next Article
Cite
Article Category: Research Article
Published Online: Mar 22, 2023
Page range: 127 - 139
Received: Dec 29, 2022
Accepted: Jan 30, 2023
DOI: https://doi.org/10.2478/raon-2023-0012
© 2023 Zixiong Chen, Xiaobo Fu, Zhenkang Qiu, Maoyuan Mu, Weiwei Jiang, Guisong Wang, Zhihui Zhong, Han Qi, Fei Gao, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Patient flow diagram. TACE = transarterial chemoembolization; MWA = microwave ablation
Patient flow diagram. TACE = transarterial chemoembolization; MWA = microwave ablation

Figure 2

Kaplan-Meier curves comparing progression-free survival (PFS) and overall survival overall survival (OS) from different groups. (A) Cumulative PFS between the unmatched A and B groups. (B) Cumulative PFS between the matched A and B groups. (C) Cumulative OS between the unmatched A and B groups. (D) Cumulative OS between the matched A and B groups.
Kaplan-Meier curves comparing progression-free survival (PFS) and overall survival overall survival (OS) from different groups. (A) Cumulative PFS between the unmatched A and B groups. (B) Cumulative PFS between the matched A and B groups. (C) Cumulative OS between the unmatched A and B groups. (D) Cumulative OS between the matched A and B groups.

Figure 3

Kaplan-Meier curves comparing progression-free survival (PFS) and overall survival (OS) according to the statistically significant prognostic factors in the multivariate analysis after propensity score-match. (A) Cumulative PFS between portal vein tumor thrombosis (PVTT) and None-PVTT patients. (B). Cumulative OS between male and female. (C) Cumulative OS between Barcelona clinic liver cancer (BCLC) B and C stages patients.
Kaplan-Meier curves comparing progression-free survival (PFS) and overall survival (OS) according to the statistically significant prognostic factors in the multivariate analysis after propensity score-match. (A) Cumulative PFS between portal vein tumor thrombosis (PVTT) and None-PVTT patients. (B). Cumulative OS between male and female. (C) Cumulative OS between Barcelona clinic liver cancer (BCLC) B and C stages patients.

Figure 4

Subgroup analyses revealed by Kaplan-Meier curves comparing progression-free survival (PFS). (A) Comparison of the PFS between portal vein tumor thrombosis (PVTT) and None-PVTT patients in group B. (B) Comparison of the PFS between PVTT and None-PVTT patients in group A. (C) Comparison of the PFS between group A and B in patients with PVTT. (D) Comparison of the PFS between group A and B in none-PVTT patients. (E) Comparison of the PFS between group A and B in high-risk location 1. (F) Comparison of the PFS between group A and B in high-risk location 2.
Subgroup analyses revealed by Kaplan-Meier curves comparing progression-free survival (PFS). (A) Comparison of the PFS between portal vein tumor thrombosis (PVTT) and None-PVTT patients in group B. (B) Comparison of the PFS between PVTT and None-PVTT patients in group A. (C) Comparison of the PFS between group A and B in patients with PVTT. (D) Comparison of the PFS between group A and B in none-PVTT patients. (E) Comparison of the PFS between group A and B in high-risk location 1. (F) Comparison of the PFS between group A and B in high-risk location 2.

Complications related to the procedure

Adverse events Group A (N = 49) AE Grade
 Group B (N = 98) AE Grade
 P value
1 2 3-4 1 2 3-4
Fever 3 3 0 0 3 9 10 0 0.608‡
Nausea 5 3 2 0 5 9 11 0 0.852†
Diarrhea 3 2 1 0 3 5 5 0 1‡
Pain required treatment 13 10 3 0 13 39 42 0 0.007†*
Liver abscess 0 0 0 0 0 1 1 0 1‡
Puncture hemorrhage 1 1 0 0 1 5 8 0 0.274‡
Displacement of seeds 0 0 0 0 0 - - - -
RILD 0 0 0 0 0 - - - -

Intrahepatic and high-risk locations tumor responses in the two groups after propensity score matching (PSM)

Tumor response Intrahepatic Tumor Tumor in high-risk locations
Group A (n = 49) Group B (n = 98) P value Group A (n = 49) Group B (n = 98) P value
Complete response (CR) 4 6 5 9
Partial response (PR) 21 23 28 29
Stable disease (SD) 17 41 13 40
Progressive disease (PD) 7 28 3 20
Objective response rate (ORR) (%) 51.0% 29.6% 0.011†* 67.3% 38.8% < 0.001†*
Disease control rate (DCR) (%) 85.7% 71.4% 0.055† 93.9% 79.6% 0.025†*

Baseline patient characteristics before and after propensity score-matched

Parameter Total (N = 181) Total cohort PSM cohort
Group A Group B P Group A Group B P
N = 49 N = 132 value N = 49 N = 98 value
Sex 0.37 0.751
Male 162 (89.5%) 46 (93.9%) 116 (87.9%) 46 (93.9%) 89 (90.8%)
Female 19 (10.5%) 3 (6.12%) 16 (12.1%) 3 (6.12%) 9 (9.18%)
Age (y) 56.0 [47.0;64.0] 56.0 [47.0;68.0] 55.5 [48.0;62.0] 0.425 56.0 [47.0;68.0] 55.0 [48.0;62.0] 0.468
BCLC 0.041* 1
B 72 (39.8%) 13 (26.5%) 59 (44.7%) 13 (26.5%) 26 (26.5%)
C 109 (60.2%) 36 (73.5%) 73 (55.3%) 36 (73.5%) 72 (73.5%)
Maximum median (IQR), tumor mm diameter, 29.0 [18.0;49.0] 36.0 [22.0;53.0] 26.5 [18.0;46.0] 0.039* 36.0 [22.0;53.0] 31.0 [18.0;57.8] 0.579
Tumor number 0.927 0.66
1-2 60 (33.1%) 17 (34.7%) 43 (32.6%) 17 (34.7%) 29 (29.6%)
≥ 3 121 (66.9%) 32 (65.3%) 89 (67.4%) 32 (65.3%) 69 (70.4%)
PVTT 0.202 1
None 108 (59.7%) 25 (51.0%) 83 (62.9%) 25 (51.0%) 49 (50.0%)
Yes 73 (40.3%) 24 (49.0%) 49 (37.1%) 24 (49.0%) 49 (50.0%)
Distant metastasis 0.171 0.953
None 109 (60.2%) 25 (51.0%) 84 (63.6%) 25 (51.0%) 52 (53.1%)
Yes 72 (39.8%) 24 (49.0%) 48 (36.4%) 24 (49.0%) 46 (46.9%)
High risk location 0.045* 0.76
1 98 (54.2%) 33 (67.3%) 65 (49.2%) 33 (67.3%) 62 (63.3%)
2 83 (45.8%) 16 (32.7%) 67 (50.8%) 16 (32.7%) 36 (36.7%)
TACE sessions 2.00 [1.00;3.00] 2.00 [1.00;2.00] 2.00 [1.00;3.00] 0.442 2.00 [1.00;2.00] 1.00 [1.00;3.00] 0.464
MWA sessions 1.00 [0.00;2.00] 1.00 [0.00;2.00] 1.00 [0.00;2.00] 0.162 1.00 [0.00;2.00] 1.00 [0.00;2.00] 0.31
Cause of liver disease: 0.09 0.181
Continued
HCV/HBV 169 (93.4%) 43 (87.8%) 126 (95.5%) 43 (87.8%) 93 (94.9%)
Other 12 (6.6%) 6 (12.2%) 6 (4.55%) 6 (12.2%) 5 (5.10%)
ECOG score 0.189 0.669
0 126 (69.6%) 30 (61.2%) 96 (72.7%) 30 (61.2%) 65 (66.3%)
1 55 (30.4%) 19 (38.8%) 36 (27.3%) 19 (38.8%) 33 (33.7%)
Child-pugh score 0.563 0.386
A 82 (45.3%) 46 (93.9%) 36 (27.3%) 46 (93.9%) 86 (87.8%)
B 99 (54.7%) 3 (6.12%) 96 (72.7%) 3 (6.12%) 12 (12.2%)
AFP, ng/mL 0.811 0.576
< 400 125 (69.1%) 35 (71.4%) 90 (68.2%) 35 (71.4%) 64 (65.3%)
≥ 400 56 (30.9%) 14 (28.6%) 42 (31.8%) 14 (28.6%) 34 (34.7%)
PT (s) 12.2 [11.5;13.1] 12.0 [11.5;12.8] 12.3 [11.6;13.1] 0.167 12.0 [11.5;12.8] 12.2 [11.5;13.1] 0.331
ALB (g/L) 40.35 [36.2;43.9] 40.8 [36.7;44.1] 40.2 [36.0;43.9] 0.329 40.8 [36.7;44.1] 40.3 [36.1;44.1] 0.518
TBIL (mg/dL) 13.55 [10.1;19.32] 12.3 [8.73;18.2] 14.6 [10.4;20.4] 0.167 12.3 [8.73;18.2] 14.6 [10.1;20.2] 0.227

Multivariate analyses of predictors of progression-free survival after treatment

Risk Factor Univariate Multivariate
HR 95%CI P value HR 95%CI P value
Sex
Female 1
Male 0.755 0.393–1.451 0.399
Age (y)
< 60 1
≥ 60 1.093 0.761–1.569 0.63
Maximum diameter (tumor mm) 1.006 1.000–1.013 0.071* 1.003 0.996-1.010 0.458
Tumor number
1-2 1
≥ 3 1.104 0.915–1.332 0.302
BCLC stage
B 1
C 1.395 0.929–2.095 0.109
High-risk location
1 1
2 0.665 0.456–0.970 0.034** 0.846 0.550-1.302 0.447
PVTT
None
Yes 1.615 1.124–2.319 0.010** 1.625 1.015-2.546 0.040**
Distant metastasis
None
Yes 1.099 0.772–1.565 0.602
TACE sessions 1.062 0.964–1.170 0.223
MWA sessions 1.006 0.914–1.106 0.905
Treatment
TACE+MWA 1
TACE+MWA+ 125I 0.527 0.357–0.778 0.002** 0.479 0.328-0.733 <0.001**
Cause of liver disease
Other 1
HBV/HCV 1.36 0.662–2.791 0.402
ECOG score
0 1
1 1.269 0.876–1.837 0.208
AFP
≤ 400 ng/mL 1
Continued
> 400 ng/mL 1.72 1.164–2.542 0.006** 1.403 0.948-2.129 0.090
Prothrombin time (s) 0.942 0.827–1.073 0.367
Albumin (g/L) 0.987 0.951–1.024 0.477
Continued
Total Bilirubin (μmol/L) 1.001 0.995–1.008 0.649
Child-pugh class
A 1
B 1.216 0.654–2.263 0.536
eISSN:
1581-3207
Language:
English
Publication timeframe:
4 times per year
Journal Subjects:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
Journal RSS Feed