Supplementary Material for: Increased Arterio-Portal Shunt Formation after Drug-Eluting Beads TACE for Hepatocellular Carcinoma

Background and Aims: Conventional transcatheter arterial chemoembolization (C-TACE) and drug-eluting bead (DEB)-based TACE are current treatments for hepatocellular carcinoma (HCC). We compared the therapeutic efficacies and adverse events of these methods in a single-center retrospective cohort study. Methods: We enrolled 174 patients treated between January 2010 and October 2016; 98 and 76 underwent C-TACE and DEB-TACE, respectively, with 76 and 22 of the former group and 49 and 27 of the latter group classified as Child-Pugh class A and B, respectively. Therapeutic outcomes, progression-free survival (PFS), and adverse events were evaluated. Results: The PFS rates in the C-TACE and DEB-TACE groups were 8.1 and 6.1 months, respectively (p = 0.79). The response and disease control rates were 64 and 71% in C-TACE patients and 69 and 78% in DEB-TACE patients, respectively (p = 0.25). Postprocedural pain, vomiting, and fever were more frequent following C-TACE than DEB-TACE (p < 0.001). In contrast, the incidences of bilomas and arterio-portal shunts were significantly higher following DEB-TACE (p < 0.001); the incident rates of arterio-portal shunt formation were 8.1 and 48.7% in patients undergoing C-TACE and DEB-TACE, respectively. Child-Pugh class A was significantly associated with arterio-portal shunt formation after DEB-TACE on multivariate analysis. Conclusions: There were no significant differences in the therapeutic efficacies of C-TACE and DEB-TACE. However, the frequency of arterio-portal shunt formation was significantly higher in HCC patients with Child-Pugh class A undergoing DEB-TACE. Our findings imply that C-TACE should be selected for HCC patients with Child-Pugh class A and DEB-TACE should be chosen for those with Child-Pugh class B.

研究背景与目的：常规经导管动脉化疗栓塞术（conventional transcatheter arterial chemoembolization, C-TACE）与载药微球经导管动脉化疗栓塞术（drug-eluting bead TACE, DEB-TACE）是当前肝细胞癌（hepatocellular carcinoma, HCC）的临床治疗手段。本研究通过单中心回顾性队列研究，对比两种术式的治疗效果与不良事件。
研究方法：本研究纳入2010年1月至2016年10月期间接受治疗的174例患者，其中98例行C-TACE，76例行DEB-TACE。C-TACE组中，76例、22例分别为Child-Pugh A级（Child-Pugh class A）与Child-Pugh B级（Child-Pugh class B）；DEB-TACE组中，49例、27例分别为Child-Pugh A级（Child-Pugh class A）与Child-Pugh B级（Child-Pugh class B）。本研究对患者的治疗结局、无进展生存期（progression-free survival, PFS）及不良事件进行评估。
研究结果：C-TACE组与DEB-TACE组的中位无进展生存期分别为8.1个月和6.1个月（p=0.79）。C-TACE组的客观缓解率与疾病控制率分别为64%和71%，DEB-TACE组分别为69%和78%（p=0.25）。C-TACE术后疼痛、呕吐及发热的发生率显著高于DEB-TACE组（p<0.001）；与之相反，DEB-TACE术后胆汁瘤（bilomas）与动门静脉分流（arterio-portal shunts）的发生率显著更高（p<0.001）：C-TACE组与DEB-TACE组的动门静脉分流发生率分别为8.1%和48.7%。多因素分析显示，Child-Pugh A级与DEB-TACE术后动门静脉分流形成存在显著相关性。
研究结论：C-TACE与DEB-TACE的治疗效果无显著差异。但接受DEB-TACE治疗的Child-Pugh A级肝细胞癌患者，其动门静脉分流形成的发生率显著更高。本研究结果提示，Child-Pugh A级肝细胞癌患者应优选C-TACE治疗，而Child-Pugh B级患者则应选用DEB-TACE。