Transarterial chemoembolization with prophylactic right inferior phrenic artery embolization for hepatocellular
Chao Ma1, Yan Wang1, Yan-Hua Bai1
1Chinese PLA General Hospital, Beijing, China.
Objectives:
This retrospective study aimed to compare the efficacy and safety of conventional lipiodol-based transarterial chemoembolization (TACE) combined with prophylactic right inferior phrenic artery (RIPA) embolization versus TACE alone for hepatocellular carcinoma (HCC) located in liver segments VII and VIII.
Methods:
After propensity score matching of 161 eligible patients, 52 received TACE alone (Group A) and 52 received TACE plus prophylactic RIPA embolization (Group B). Primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), time to progression (TTP), tumor response, and adverse events (AEs).
Results:
The combination therapy significantly improved survival outcomes. Median OS was 32.3 vs. 28.3 months, median PFS was 18.8 vs. 16.5 months, and median TTP was 19.3 vs. 17.5 months. Multivariable Cox analysis confirmed prophylactic RIPA embolization as an independent favorable prognostic factor for OS (HR 0.511, P=0.008), PFS (HR 0.528, P=0.003), and TTP (HR 0.502, P=0.002). Other independent factors included tumor number >3 and Child-Pugh class. The 1-month objective response rate showed no significant difference (67.3% vs. 55.8%, P=0.277). Regarding safety, the overall AE rate was similar between groups (44.2% vs. 42.3%). Complications specifically associated with RIPA embolization in Group B included shoulder pain (19.2%) and hiccups (13.5%), which were mild and self-limited. The incidence of major complications (SIR class C-F) was not significantly different (7.7% vs. 3.8%, P=0.678). One patient in Group B developed a grade 4 liver abscess.
Conclusions:
For HCC in segments VII/VIII, adding prophylactic RIPA embolization to conventional lipiodol-based TACE provides significant survival benefits, establishing it as an independent prognostic factor, without substantially increasing major treatment-related morbidity. This combined approach represents a valuable therapeutic strategy for this specific patient subset.
