Survival, tumour response and safety of 70-150 μm versus 100-300 μm doxorubicin drug-eluting beads in transarterial chemoembolisation for hepatocellular carcinoma

Introduction This study investigates the outcomes and safety of 70-150 mu m and 100-300 mu m doxorubicin drug-eluting bead transarterial chemoembolisation (DEB-TACE) in patients with unresectable hepatocellular carcinoma (HCC). Methods Retrospective, cohort study of 51 patients treated with DEB-TACE for unresectable HCC was studied: 23 with 100-300 mu m particles and 28 with 70-150 mu m particles. Overall, survival (OS), progression-free survival (PFS), tumour response and prognostic factors were assessed. Results The median OS of the entire cohort was 30 months. The median OS and median PFS for 70-150 mu m particles were not reached, whilst for the 100-300 mu m group, it was 29.2 months and 15.0 months, respectively. The 6-month, 1-year and 2-year OS for 70-150 mu m was 96%, 86% and 85% versus the 100-300 mu m particles size of 83%, 64% and 44%, respectively. At 1-month follow-up, patients treated with 70-150 mu m had significantly better mRECIST tumour response compared to 100-300 mu m (complete response 38.5% vs. 19%; partial response 57.7% vs. 42.9%; stable disease 0% vs. 4.8%; progressive disease 3.8% vs. 33.3%, P = 0.027). Patients treated with 100-300 mu m DEBs were significantly more likely to have progressive disease on 1-month follow-up imaging compared those treated with 70-150 mu m DEB sizes (odds ratio 7.15, P = 0.007). The 30-day mortality rate was similar between the two groups (3.6% for 70-150 mu m vs. 4.3% for 100-300 mu m). Multivariate analysis demonstrated entire cohort OS was significantly associated with BCLC stage (aHR: 10.5, P = 0.002), albumin (aHR: 15.0, P = 0.02) and ALP (aHR 62, P = 0.001). Conclusions DEB-TACE with 70-150 mu m particles demonstrates improved 1-month objective tumour response compared to 100-300 mu m, whilst having a similar safety profile. Elevated ALP, lower albumin and higher BCLC stage were significantly associated with poorer survival outcomes.