Efficacy and Safety of Drug-Loaded Microsphere-Based Transcatheter Arterial Chemoembolization for the Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

In this study, we evaluate the effectiveness and safety of conventional transcatheter arterial chemoembolization (C-TACE) and drug-loaded microsphere-based TACE (DEB-TACE) in patients with hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombus (PVTT). A total of 51 HCC patients with PVTT treated at our hospital between August 2016 and December 2021 were collected and retrospectively analyzed. 39 patients were in the DEB-TACE group and 9 patients were in the C-TACE group, after excluding 3 patients. Serum alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) levels were assessed using magnetic nanoparticle-based chemiluminescence immunoassay. The liver function was evaluated before TACE, at 1 month, and at 3 months after treatment. The therapeutic response and intraoperative and postoperative adverse events were analyzed in two groups. Both TACE treatments effectively reduced tumor thrombus size, tumor count, and PVTT classification, with DEB-TACE demonstrating superior efficacy. The median survival time was slightly longer in the DEB-TACE group (14 months) compared to the c-TACE group (11 months), but there were no significant differences in the survival curves. Both groups experienced decreased postoperative AFP levels, while PIVKA-II levels remained stable without significant differences between the two groups. The PIVKA-II index exhibited no significant alteration, and there was no notable disparity observed between the two groups. There were no statistically significant differences observed in liver function and postoperative adverse reactions between the two groups after the operation. In conclusion, the therapeutic effect and safety of DEB-TACE are found to be equivalent to those of C-TACE.