Endpoint of embolization: A study of transarterial chemoem-bolization in patients with large hepatocellular carcinoma

Purpose: To explore the degree of embolization and embolization endpoints in patients with large hepatocellular carcinoma (HCC) treated via transarterial chemoembolization (TACE). Methods: Thirty-two HCC patients treated with TACE from 2015 to 2016 who met the enrollment criteria for this study were retrospectively analyzed. The experimental group was treated via complete embolization, with complete occlusion of the tumor blood supplying artery, while the control group underwent incomplete embolization of any blood supplying arteries, with limited residual visible blood flow detectable via angiography. Postoperative liver and kidney function, complications, prognosis, and survival for patients in these two groups were analyzed. Results: There was no significant difference at baseline patient condition between the two treatment groups before treatment. After treatment, the alanine aminotransferase (ALT), aspartic aminotransferase (AST), and white blood cell (WBC) values in the experimental group were significantly higher than those in the control group (p=0.031, 0.038, and 0.034, respectively). There was also a significant increase in hepatic aseptic necrosis and acute liver function damage in the experimental group relative to the control group (p=0.015 and 0.023, respectively). Compared with the control group, the prognosis and survival of the experimental group was significantly decreased. Univariate and multivariate Cox regression analyses of overall survival revealed that the different treatment group and hepatitis B infection status were the main factors affecting patient prognosis and survival. Conclusions: For patients with large HCC tumors with a limited number of supporting arteries, careful attention should be paid to the use of embolic agents during the TACE procedure. Rather than proceeding to complete embolization of the artery root, embolization can be terminated when the main tumor feeding artery is still faintly visible on an angiogram in a structure reminiscent of a tree with dry branches, thereby reducing adverse outcomes in patients.