Simultaneous transcatheter arterial chemoembolization and portal vein embolization for patients with large hepatocellular carcinoma before major hepatectomy

Table 1 Demographic and pathological characteristics

Characteristics	siTP group (n = 13)	seTP group (n = 17)	PVE-only group (n = 21)	P value
Male, n (%)	10 (77)	13 (76)	17 (81)	0.935
Age (yr)	51.5 ± 10.0	54.0 ± 11.2	59.2 ± 8.3	0.068
Etiology, n (%)				0.928
HBV	9 (69)	12 (70)	15 (71)
Alcoholic	1 (8)	2 (12)	2 (10)
NASH	3 (23)	3 (18)	3 (14)
Schistosomiasis	0	0	1 (5)
ECOG performance status, n (%)				0.725
0	10 (77)	13 (76)	18 (86)
1	3 (23)	4 (24)	3 (14)
Tumor multiplicity, n (%)				0.809
Single	11 (85)	14 (82)	15 (71)
Multiple	2 (15)	3 (18)	6 (29)
Tumor size (cm)	8.4 ± 2.7	8.3 ± 2.3	7.7 ± 1.9	0.630
ICGR15 (%)	5.7 ± 3.0	5.0 ± 2.6	6.0 ± 2.7	0.511
Baseline FLR (%)	31.2 ± 3.7	31.8 ± 4.5	33.2 ± 3.5	0.150
AFP (ng/mL)	377 (11-3419)	487 (16-12000)	551 (9-10344)	0.640
ALT (U/mL)	30.2 ± 13.8	40.5 ± 26.0	40.4 ± 24.0	0.380
AST (U/mL)	39.5 ± 16.2	58.2 ± 40.0	49.5 ± 20.8	0.212
TBIL (μg/mL)	19.0 ± 5.1	17.4 ± 5.2	21.2 ± 6.9	0.147

HBV: Hepatitis B virus; NASH: Non-alcoholic steatohepatitis; ICGR15: Indocyanine green retention rate at 15 min; FLR: Future liver remnant; AFP: Alpha-fetoprotein; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TBIL: Total bilirubin; seTP: Sequential TACE + PVE; siTP: Simultaneous TACE + PVE.

Table 2 Outcomes after portal vein embolization with or without transarterial chemoembolization and before hepatectomy

Variable	siTP group (n = 13)	seTP group (n = 17)	PVE-only group (n = 21)	P value
FLR (%) (before hepatectomy)	45.9 ± 4.2	43.3 ± 6.6	43.0 ± 4.7	0.262
Interval from TACE/PVE to hepatectomy	16.2 ± 2.7	37.9 ± 6.5	35.4 ± 10.6	< 0.001
KGR (%)	21.1 ± 5.9	7.6 ± 2.9	6.8 ± 3.6	< 0.001
Tumor size reduction, n (%)	13 (100)	13 (76)	2 (10)	< 0.001
Complications, n (%)				0.875
Abdominal pain	6 (46)	9 (53)	3 (14)
Fever	7 (54)	8 (47)	3 (14)
Nausea	2 (15)	4 (24)	2 (10)
Acute pulmonary infarction	0	1 (6)	0

FLR: Future liver remnant; TACE: Transarterial chemoembolization; PVE: Portal vein embolization; KGR: Kinetic growth rate; seTP: Sequential TACE + PVE; siTP: Simultaneous TACE + PVE.

Table 3 Introperative and postoperative outcomes of three groups

Variables	siTP group (n = 13)	seTP group (n = 17)	PVE-only group (n = 21)	P value
Patients with major hepatectomy, n (%)	13 (100)	14 (82)	14 (67)	0.057
Surgical approach, n (%)				0.868
Right hemihepatectomy	9 (69)	12 (71)	9 (43)
Right hepatic trisegmentectomy	2 (15)	1 (6)	3 (14)
Left hemihepatectomy	1 (8)	0	1 (5)
Left hepatic trisegmentectomy	1 (8)	1 (6)	1 (5)
Operation time (min)	261.4 ± 51.8	210.7 ± 53.7	246.1 ± 66.4	0.080
Intraoperative blood loss (mL)	285.0 ± 138.7	265.7 ± 153.6	343.9 ± 136.7	0.266
Transfusion, n (%)	4 (31)	4 (29)	2 (10)	0.550
Hospital stay after surgery (d)	10.9 ± 2.1	11.9 ± 3.9	12.3 ± 3.4	0.503
Complications, n (%)				0.842
Liver failure	1 (8)	0	2 (10)
Bilirary fistula	3 (23)	4 (24)	2 (10)
Hydroperitonium	1 (8)	2 (12)	0
Hydrothorax	2 (15)	1 (6)	1 (5)
Abdominal infection	2 (15)	1 (6)	1 (5)
Perioperative death, n (%)	0	0	1 (5)	0.372
Pathologic response, n (%)				< 0.001
MPR (RT < 10%)	6 (46)	2 (12)	0
PPR (RT from 10% to 50%)	3 (23)	2 (12)	0

MPR: Major pathological response; RT: Residual tumor cells; PPR: Partial pathological response; TACE: Transarterial chemoembolization; PVE: Portal vein embolization; seTP: Sequential TACE + PVE; siTP: Simultaneous TACE + PVE.