This retrospective study showed that the combination of sorafenib with transarterial chemoembolization and radiofrequency ablation resulted in a significant survival benefit in patients with medium or large hepatocellular carcinoma when compared with results in patients who underwent only transarterial chemoembolization and radiofrequency ablation. Purpose To determine the safety and efficacy of sorafenib combined with transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) (hereafter, S-TACE-RFA) in patients with medium or large (range, 3.1–7.0 cm in diameter) hepatocellular carcinoma (HCC). Materials and Methods This retrospective study evaluated the medical records of consecutive patients with medium or large HCC who underwent S-TACE-RFA or combined TACE and RFA (hereafter, TACE-RFA) from January 2010 to December 2014. Sorafenib was started 3–5 days after TACE, and RFA was performed 1–2 weeks after TACE. Treatment complications, recurrence-free survival (RFS), and overall survival (OS) in patients who underwent S-TACE-RFA were compared with those in patients who underwent TACE-RFA. Results Of the 174 patients who underwent S-TACE-RFA or TACE-RFA, 106 who met the eligibility criteria were included in this study. Among them, 40 underwent S-TACE-RFA and 66 underwent TACE-RFA. The patients who underwent S-TACE-RFA had longer RFS (med...

Inflammation-related nomogram for predicting survival of patients with unresectable hepatocellular carcinoma received conversion therapy

We aimed to evaluate the feasibility and safety of a modified technique for portal vein recanalization, percutaneous transluminal sharp recanalization (PTSR), when performing transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of chronic portal vein occlusion (CPVO) and portal hypertension. Nine consecutive patients with CPVO and portal hypertension had undergone TIPS and PTSR procedure after failing in conventional percutaneous catheterization from March 2017 to July 2019. Technical success rates, effectiveness, and complications were evaluated. Follow-up of patients' clinical outcomes and shunt patency were performed periodically. Primary and secondary shunt patency were analyzed by Kaplan-Meier method. The occluded portal veins were successfully recanalized after failing in conventional percutaneous catheterization, and TIPS procedures were completed in all 9 patients. Two patients suffered from procedure-related complications. A portosystemic pressure gradient <12 mmHg, or a percent reduction of 25% to 50% of baseline, was achieved in all 9 patients after TIPS. During the median follow-up period of 28 months (range, 9-36 months), 1 patient experienced recurrent ascites and the other 8 patients remained asymptomatic. The cumulative rates of primary and secondary shunt patency were 66.67% and 100%, respectively, at 2 years. As a supplementary method, PTSR is a feasible and safe method for portal vein recanalization when performing TIPS for patients with CPVO and portal hypertension.

Background: Transarterial chemoembolization (TACE) combined with Lenvatinib plus programmed death-1 inhibitor (PD-1 inhibitor) is recommended for unresectable hepatocellular carcinoma (uHCC), and it has increased the probability of successful conversion. Our aim was to compare the clinical benefits of TACE combined with Lenvatinib-PD-1 inhibitor versus TACE monotherapy as conversion therapy for patients with uHCC who subsequently underwent liver resection (LR). Materials and Methods: This retrospective study included 213 uHCC patients who underwent LR after receiving either TACE combined with Lenvatinib plus PD-1 inhibitor (combination group, n=109) or TACE monotherapy (monotherapy group, n=104). Propensity score matching was employed to minimize baseline confounding variables between cohorts. Tumor response, disease-free survival (DFS), overall survival (OS), and adverse events (AEs) were assessed between treatment arms. Results: Among 68 matched pairs of patients who underwent LR, only 1 patient developed small-for-size syndrome. The combination group demonstrated superior treatment responses compared with the monotherapy group, with a significantly higher objective response rate (92.65% vs 80.88%, p=0.043) and pathological complete response rate (36.76% vs 11.76%, p< 0.001). Furthermore, histopathological analyses revealed a lower incidence of microvascular invasion in the combination group compared with the monotherapy group (14.71% vs 29.41%, p=0.039). Survival analyses demonstrated significantly improved DFS (median not reached vs 20.0 months, p=0.002) and OS (median not reached for both, p=0.005) in the combination group. Multivariate Cox proportional hazards regression identified preoperative monotherapy as an independent adverse prognostic factor for both DFS (HR, 2.46) and OS (HR, 3.05). Although combination therapy showed superior therapeutic efficacy, it was linked to a significantly higher incidence of rash and hand-foot skin reactions. Conclusion: Compared to TACE monotherapy, TACE combined with Lenvatinib-PD-1 inhibitor as conversion therapy can improve long-term survival outcomes in patients with uHCC who undergo subsequent LR, with an acceptable safety profile.

This retrospective study evaluated the long-term patency of transjugular intrahepatic portosystemic shunt (TIPS) placement and identified predictors of shu