Transarterial Chemoembolization for Hepatocellular Carcinoma in Clinical Practice: Temporal Trends and Survival Outcomes of an Iterative Treatment

Frontiers in Oncology

Oncology

Maria Guarino¹  Gerardo Nardone²  Giovanni Raimondo³  Maurizia Rossana Brunetto⁴  Claudia Campani⁵  Ciro Celsa⁶  Francesco Giuseppe Foschi⁷  Gianpaolo Vidili⁸  Fabio Farinati⁹  Filippo Pelizzaro⁹  Selion Haxhi⁹  Barbara Penzo⁹  Alessandro Vitale^1,10  Vito Sansone^1,11  Eugenio Caturelli^1,12  Andrea Mega^1,13  Edoardo G. Giannini^1,14  Francesco Azzaroli^1,15  Gian Ludovico Rapaccini^1,16  Alberto Masotto^1,17  Gianluca Svegliati-Baroni^1,18  Rodolfo Sacco^1,19  Andrea Olivani^2,20  Donatella Magalotti^2,21  Antonio Gasbarrini^2,22  Franco Trevisani^2,23  Maria Di Marco^2,24 

[1]Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli “Federico II”, Napoli, Italy

[2]Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli “Federico II”, Napoli, Italy

[3]Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Messina, Italy

[4]Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory and Internal Medicine Unit, University of Pisa, Pisa, Italy

[5]Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Firenze, Italy

[6]Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties (PROMISE), Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Italy

[7]Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy

[8]Department of Internal Medicine, Ospedale per gli Infermi di Faenza, AUSL Romagna, Faenza, Italy

[9]Department of Medical, Surgical and Experimental Sciences, Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy

[10]Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy

[11]Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, University of Padova, Padova, Italy

[12]Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

[13]Gastroenterology Unit, Belcolle Hospital, Viterbo, Italy

[14]Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy

[15]Gastroenterology Unit, Department of Internal Medicine, University of Genova, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy

[16]Gastroenterology Unit, Department of Surgical and Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

[17]Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy

[18]Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy

[19]Gastroenterology Unit, Polytechnic University of Marche, Ancona, Italy

[20]Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy

[21]Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy

[22]Internal Medicine Unit, Department of Medical and Surgical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

[23]Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Roma, Italy

[24]Medical Semeiotics Unit, Department of Medical and Surgical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

[25]Medicine Unit, Bolognini Hospital, Seriate, Italy

关键词: hepatocellular carcinoma;    transarterial chemoembolization;    survival;    iterative treatment;    therapeutic hierarchy;   

DOI  :  10.3389/fonc.2022.822507

 received in 2021-11-25, accepted in 2022-01-07,  发布年份 2022

来源: Frontiers

【 摘 要 】

BackgroundTransarterial chemoembolization (TACE) is one of the most frequently applied treatments for hepatocellular carcinoma (HCC) worldwide. In this study, we aimed at evaluating whether and how TACE application and repetition, as well as the related outcome, have changed over the last three decades in Italy.MethodsData of 7,184 patients with HCC were retrieved from the Italian Liver Cancer (ITA.LI.CA) database. Patients were divided according to the period of diagnosis in six cohorts: P1 (1988–1993), P2 (1994–1998), P3 (1999–2004), P4 (2005–2009), P5 (2010–2014), and P6 (2015–2019). All the analyses were repeated in the overall patient population and in Barcelona Clinic Liver Cancer (BCLC) B patients, who are the subgroup of HCC patients originally supposed to receive TACE according to guidelines. TACE was defined as either the first or the main (more effective) treatment.ResultsThe proportion of patients receiving TACE as first or main therapy declined over time, and less than 50% of BCLC B patients were treated with chemoembolization from P3 onward. Conversely, TACE was widely used even outside the intermediate stage. Survival of TACE-treated patients progressively increased from P1 to P6. Although TACE was performed only once in the majority of patients, there was an increasing proportion of those receiving 2 or ≥3 treatments sessions over time. The overall survival (OS) of patients undergoing repeated treatments was significantly higher compared to those managed with a single TACE (median OS 40.0 vs. 65.0 vs. 71.8 months in 1, 2, and ≥3 TACE groups, respectively; p < 0.0001). However, after a first-line TACE, the adoption of curative therapies provided longer survival than repeating TACE (83.0 vs. 42.0 months; p < 0.0001), which in turn was associated with better outcomes compared to systemic therapies or best supportive care (BSC).ConclusionsDespite a decline in the percentage of treated patients over time, TACE has still an important role in the management of HCC patients. The survival of TACE-treated patients gradually improved over time, probably due to a better patient selection. Iterative TACE is effective, but an upward shift to curative therapies provides better outcomes while transition to systemic therapies and BSC leads to a worse prognosis.

【 授权许可】

Unknown   
Copyright © 2022 Pelizzaro, Haxhi, Penzo, Vitale, Giannini, Sansone, Rapaccini, Di Marco, Caturelli, Magalotti, Sacco, Celsa, Campani, Mega, Guarino, Gasbarrini, Svegliati-Baroni, Foschi, Olivani, Masotto, Nardone, Raimondo, Azzaroli, Vidili, Brunetto, Trevisani and Farinati