Background: Diabetes is prevalent among patients with hepatocellular carcinoma (HCC) and is associated with a poor prognosis. Although the hypoglycemic drug metformin has shown antitumor effects, its potential positive effect on patients with HCC and diabetes undergoing transarterial chemoembolization (TACE) remains unclear. Therefore, this study aimed to investigate the efficacy and safety of metformin in patients with HCC and type II diabetes who are receiving TACE. Materials and methods: This retrospective study involved 372 consecutive patients with HCC and type II diabetes across three medical centers between January 2014 and June 2021. All patients underwent TACE. Propensity score matching (PSM) was used to reduce selection bias. Cox proportional hazards regression was employed to compare all-cause death between the metformin and nonmetformin groups while competing risk regression was performed to assess cancer-specific death. Results: Among 372 patients included in the study, 208 patients (177 male patients and 31 female patients) with a mean age of 59.6 (10.3) years received metformin, and 164 patients (139 male patients and 25 female patients) with a mean age of 60.3 (10.0) years did not. Before PSM, patients with metformin had significantly longer median overall survival (mOS) and median progression-free survival (mPFS) than those without metformin (mOS: 34 months, 95% CI: 25.6–42.4 vs. 20 months, 95% CI: 15.3–24.7; P <0.001; mPFS: 11 months, 95% CI: 9.3–12.7 vs. 8 months, 95% CI: 5.9–10.1; P <0.001). Similar results were observed after PSM. Multivariate regression analysis indicated that metformin was associated with a reduced risk of all-cause mortality (HR: 0.589, 95% CI: 0.454–0.763; P <0.001) and tumor progression (HR: 0.667, 95% CI: 0.526–0.845; P =0.001) before PSM. After excluding deaths related to other factors, metformin continued to demonstrate a reduction in cancer-specific mortality risk among the patients. Subgroup analysis further revealed that patients using metformin had lower all-cause mortality risk and tumor progression risk than those without metformin in most subgroups. Adverse event evaluation suggested that metformin could lead to elevated nausea incidence. Conclusion: Metformin may confer survival benefits to patients with HCC and type II diabetes undergoing TACE. Metformin may simultaneously address multiple aspects of treatment in these patients.

Objectives. To evaluate the efficacy and safety of transarterial chemoembolization (TACE) with drug-eluting beads (DEB-TACE) and lipiodol (DEB-Lipiodol TACE) in the treatment of unresectable hepatocellular carcinoma (HCC) patients. Materials and Methods. The medical records of consecutive unresectable HCC patients who underwent DEB-TACE or DEB-Lipiodol TACE from June 2016 to July 2021 were retrospectively evaluated. Therapeutic response, overall survival (OS), progression-free survival (PFS), and adverse events (AEs) were compared among the groups. Results. Three hundred and twenty-seven patients were enrolled in the study, including 293 patients in the DEB-TACE group and 34 patients in the DEB-Lipiodol TACE group. The objective response rate in the DEB-Lipiodol TACE group was 17.6%, significantly higher than that in the DEB-TACE group (5.8%, ). Similarly, DEB-Lipiodol TACE group also had a higher disease control rate (91.2% vs 68.6%, ). Median OS was 13 months (95% CI: 11.0 months and 15.0 months) and 22 months (95% CI: 17.3 months and 26.7 months) in the DEB-TACE group and DEB-Lipiodol TACE group, respectively ( ). Meanwhile, median PFS was 7 months (95% CI: 5.2 months and 8.8 months) in the DEB-TACE group and 12 months (95% CI: 7.9 months and 16.1 months) in the DEB-Lipiodol TACE group ( ). There was no statistically significant difference in AEs incidence among the two groups ( ). Conclusions. DEB-Lipiodol TACE was safe, well tolerated, and had a better efficacy compared with DEB-TACE in unresectable HCC patients.

BackgroundThe efficacy of RFA in the treatment of HCC with severe fibrosis is still unclear. The objective of this study is to compare the efficacy of RFA with liver resection in the treatment of HCC within Milan criteria.MethodsThe data used in the study were from the SEER database. Patients with HCC within Milan criteria were included in the study. A total of 1432 patients were included in the study; among them, 1038 patients received RFA, and 394 patients received liver resection. Propensity score matching (PSM) was used to reduce selection bias.ResultsBefore PSM, the median overall survival (mOS) and median cancer-specific survival (mCSS) in the resection group were longer than the mOS and mCSS in the RFA group. However, the8re were no statistically significant differences in mOS or mCSS between the two groups (both P>0.05). After PSM, similar results were presented, and the mOS and mCSS in the resection group were similar to those in the RFA group (both P>0.05). The multivariable Cox regression analysis showed that RFA did not increase the all-cause mortality risk and cancer-specific mortality risk compared with resection before PSM. In the competing risk analysis, after excluding the potential factors that might influence the outcomes, RFA still did not increase the mortality risk compared with resection before PSM and after PSM. In the subgroup analysis. The efficacy of RFA is comparable to that of resection in patients with tumor sizes no more than 3 cm before PSM and after PSM.ConclusionThe efficacy of RFA is similar to that of resection in the treatment of early HCC patients with severe fibrosis, especially in patients with tumor sizes no more than 3 cm.

BackgroundThere are no exact treatments been recommended for gastrointestinal tumor liver metastasis patients. This study intends to assess the safety and efficacy of transarterial chemoembolization (TACE) plus apatinib as a combination treatment for gastrointestinal tumor liver metastasis patients.MethodsFrom January 2015 to December 2019, 53 patients with gastrointestinal tumor liver metastases were included in the analysis.ResultsThe median progression-free survival (mPFS) and median overall survival (mOS) numbers were 7 months and 17 months, respectively. The mPFS of metastatic sites was 12 months. The disease control rate (DCR) and objective response rate (ORR) values were 86.8% (46/53) and 49.1% (26/53), respectively. The multivariate regression analysis showed that Child-Pugh and Eastern Cooperative Oncology Group (ECOG) were independent predictors for OS. The independent predictors for overall PFS include carbohydrate antigen 724 (CA 724), CA 199, TACE session, Child-Pugh, and ECOG; while for liver tumor PFS, the independent predictors are TACE session and ECOG scores. There were no changes of leukocyte, lymphocyte, carcinoemnryonicantigen (CEA), CA 724, CA 199, CA 125 of patients before receiving the treatments and one month after receiving the treatment (all P>0.05). Common adverse events at any grade were poor appetite (64.2%), hypertension (56.6%), and hand-foot syndrome (50.9%). Some patients had III or IV-grade adverse events after receiving the TACE-apatinib combination treatment. However, these adverse events alleviated after reducing apatinib administration or receiving symptomatic treatments.ConclusionsThe TACE-apatinib combination might be an effective treatment option against gastrointestinal tumors liver metastases with promising safety.