Embolizing to Complete Stasis May Deliver Survival Benefit
LOS ANGELES—Embolizing to complete stasis may convey a short-term survival benefit among patients treated with transarterial chemoembolization with drug-eluting beads (DEB-TACE), according to an abstract presented at the Society of Interventional Radiology meeting.
The investigators undertook the retrospective cohort study to determine whether substasis endpoints in DEB-TACE have better survival when compared with complete stasis endpoints in patients with hepatocellular carcinoma (HCC).
The 155 participants included in the study were aged 18 years or older, were diagnosed as having HCC, and had DEB-TACE as first-line therapy from 2008 to 2016. The patients were classified based on a review of angiographic images that assigned a subjective angiographic chemoembolization endpoint (SACE) level. The survival rate between different SACE levels was calculated using Kaplan-Meier curves, with a significance level of .05. The primary endpoint was median survival after first TACE.
Of the 155 patients, there were 98 classified as SACE level 2, 30 as SACE level 3, and 27 as SACE level 4. Among patients who survived fewer than 25 months, SACE level 4 patients had longer survival (median of 14.7 months) than SACE level 2 patients (median of 9.4 months) or level 3 patients (10.1 months). Patients who survived more than 25 months had similar rates of survival though.
“Data suggests statistically significant short-term benefit in embolization to full stasis,” the authors stated. They added, “there were no significant differences in outcomes long term, but can be helpful for downstaging.”
In the future, the authors plan additional investigations that include stratifying patients on operative risk and primary cause of death, as well as developing a timed endpoint score such as a 7-second stasis score that would help standardize the meaning of complete embolization. The authors also acknowledged the need for a randomized, prospective, multicenter analysis.
D Moon, S Fujumoto, U Oyoyo. Complete stasis embolization may convey survival benefit in hepatocellular carcinoma patients treated with doxorubicin eluting bead transcatheter arterial chemoembolization. Abstract 132. Presented at the Society of Interventional Radiology meeting. Los Angeles, California. March 19, 2018.