Influencing factors for digital subtraction angiography and cone-beam computed tomography guided bead chemoembolization in resistant liver cancer

Abstract

BACKGROUND

Transcatheter arterial chemoembolization (TACE) failure or refractoriness in hepatocellular carcinoma (HCC) refers to patients who continue to experience tumor progression or recurrence after TACE. Drug-eluting bead (DEB) TACE guided by digital subtraction angiography (DSA) is a novel interventional technique. However, the efficacy of DEB-TACE varies among patients, making the analysis of the factors influencing treatment outcomes clinically important for optimizing therapeutic strategies and improving prognosis.

AIM

To explore the factors influencing the clinical efficacy of DSA-guided DEB-TACE in the treatment of TACE failure/refractoriness in patients with HCC.

METHODS

A retrospective analysis was conducted in 96 patients with HCC who were admitted to our hospital between January 2021 and December 2023, met the criteria for TACE failure or refractoriness, and underwent real-time DSA-guided DEB-TACE. Based on the modified response evaluation criteria in solid tumors criteria assessed at the 1-year follow-up, patients were classified into a favorable-outcome group (complete or partial response) and a poor-outcome group (stable or progressive disease). The clinical data of the two groups were compared, and multivariate logistic regression analysis was conducted to identify independent factors affecting treatment outcomes.

RESULTS

Among 96 patients with HCC and TACE failure/refractoriness, 64 had favorable outcomes, whereas 32 had poor outcomes. Univariate analysis revealed that the two groups exhibited statistically significant differences (P < 0.05) in lesion diameter ≥ 5 cm, multiple lesions, Child-Pugh class B, and preoperative alpha-fetoprotein (AFP) level ≥ 400 ng/mL. Multivariate logistic regression analysis identified lesion diameter, multiple lesions, Child-Pugh classification, and preoperative AFP levels as independent risk factors for poor outcomes in patients with HCC and TACE failure or refractoriness (P < 0.05).

CONCLUSION

The efficacy of DSA-guided DEB-TACE in patients with TACE-refractory HCC is closely linked to lesion diameter, multiplicity, Child-Pugh class, and preoperative AFP levels.

Keywords: Digital subtraction angiography-guided procedure; Drug-eluting bead transcatheter arterial chemoembolization; Transcatheter arterial chemoembolization failure/refractoriness; Hepatocellular carcinoma; Influencing factors

Core Tip: This study compared the clinical data of patients with favorable and poor outcomes after digital subtraction angiography-guided drug-eluting bead- transcatheter arterial chemoembolization (TACE) for TACE-refractory hepatocellular carcinoma. This study aimed to analyze factors influencing therapeutic efficacy and identify predictive indicators. This novel technique has been innovatively evaluated in cases of conventional TACE failure or refractoriness. The results identified lesion diameter, lesion multiplicity, Child-Pugh class, and preoperative alpha-fetoprotein levels as significant factors affecting the efficacy of digital subtraction angiography-guided drug-eluting bead-TACE.