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Pathological response after degradable starch microspheres transarterial chemoembolization for hepatocellular
Federico Collettini1, Hannes Gottschalk2, Timo Alexander Auer1
1Department of Radiology, Charité University Medicine Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany.
Purpose:
To evaluate the pathological response after degradable starch microspheres transarterial chemoembolization (DSM-TACE) conducted to bridge or downstage hepatocellular carcinoma (HCC) patients to liver transplantation.
Materials And Methods:
A multi-center retrospective study was conducted on consecutive patients with HCC who underwent liver transplantation after receiving DSM-TACE as a stand-alone therapy for bridging or downstaging between January 1, 2010, and December 31, 2022. Pathological response was evaluated histologically by board certified surgical pathologists. Tumor necrosis was estimated histologically as a percentage area of the total tumor area. The criteria for estimation of pathological response were established as follows: (1) Complete pathological response: 100% tumor necrosis and absence of any viable tumor cells; (2) Significant pathological response: 50-99% tumor necrosis in cross section; (3) Mild pathological response: 1-49% tumor necrosis in cross section and (4) No pathological response: no tumor necrosis present.
Results:
Twenty-two patients (16 men; median age, 65 years) with 73 HCCs (median largest diameter: 2.7 cm) were bridged or downstaged with DSM-TACE and subsequently underwent liver transplantation. Histopathological examination of the explanted livers showed complete pathological response in 27 % of patients, significant pathological response in 32 %, mild pathological response in 27 % and no pathological response in 14 %.
Conclusion:
The present study provides important clinical evidence supporting the efficacy of DSM-TACE in inducing tumor necrosis, despite its short embolization time.
