Caudate Lobe Hepatocellular Carcinoma Treated With Sequential Transarterial Chemoembolization And Iodine 125 Seeds Implantation:Safety And Efficacy Analysis

Objectives:Resection of the hepatocellular carcinoma(HCC)originating from the caudate lobe(CL)is a complex and challenging task for accomplished operators.This study was conducted to evaluate safety and efficacy of transarterial chemoembolization(TACE)and iodine 125 seeds implantation(ISI)for unresectable or “ablation unsuitable” HCC-CL found at initial presentation in clinical practice.And compared with non-caudate lobe hepatocellular carcinoma(HCC-NCL),to explore whether the tumor location affects the efficacy of combination therapy.Methods:The clinical data of 121 patients with hepatocellular carcinoma(HCC)who received sequential TACE combined with ISI in our medical center from January2014 to October 2018 were retrospectively analyzed.According to the inclusion and exclusion criteria,a total of 20 cases of caudate-originated hepatocellular carcinoma(HCC-CL)and 57 cases of non-caudate-originated hepatocellular carcinoma(HCC-NCL)were enrolled.Overall survival(OS),progression-free survival(PFS),tumor response rate,technical success rate,adverse event and complication rate were analyzed and compared between the two groups.Multivariate analyses for potential factors were performed by using the Cox hazard model to explore prognostic factors affecting combination therapy.Results:Technical success rate was 90%,the 20 patients received a total of 28 ISI treatments,with a mean of 18.4±12.3 seeds per patients.The median OS was 35months(95%CI:27.6-42.4),the 1-,3-,and 5-years survival rates were 100%,63.2%,and 11.1%,respectively.The median PFS was 16 months(95%CI:8.7-23.3).Objective response rate was 60.0%.Bleeding of puncture tract(10%,2/20)and pneumothorax(5%,1/20)were the most common complications in operation,no operation-related deaths occurred.One year after surgery,biliary tract injury occurred in 1 patient,percutaneous biliary intervention has been needed.The baseline characteristics between CL and NCL group were comparable,no statistical difference in technical success rate,incidence of adverse events and complications,objective response rate,median OS and PFS were observed between the two groups.Multivariable analysis revealed that Barcelona Clinic Liver Cancer Stage B,tumor size>3cm were two significant factors associated with survival.Subgroup analysis of tumor diameter and BCLC stage showed no statistically significant difference in survival efficacy between the two groups.Conclusions:Sequential TACE and ISI are safe and effective in the treatment of HCC-CL,with long-term survival benefits and no difference in efficacy compared with HCC-CL.Therefore,they should be considered as an important and reliable alternative therapy for surgeons and interventional radiologists.