Drug-Eluting Microsphere Versus Cisplatin-Based Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma: Propensity Score-Matched Analysis.

Abstract

<b>OBJECTIVE.</b> The purpose of this study was to compare the safety and efficacy of transarterial chemoembolization (TACE) with 30- to 60-μm drug-eluting microspheres with those of cisplatin-based TACE in the treatment of unresectable hepatocellular carcinoma (HCC). <b>MATERIALS AND METHODS.</b> This retrospective single-center study included 607 patients who underwent drug-eluting microsphere (30-60 μm, loaded with doxorubicin) TACE (<i>n</i> = 119) or cisplatin-based TACE (<i>n</i> = 488) as first-line treatment of unresectable HCC between April 2017 and April 2018. With a propensity model correcting for selection bias, patients were selected from each treatment group to compare the effectiveness of drug-eluting microsphere TACE with that of cisplatin TACE. <b>RESULTS.</b> In the entire study population, the rates of major complications (1.7% vs 1.8%, <i>p</i> > 0.999), objective tumor response (80.7% vs 79.7%, <i>p</i> = 0.899), and time to progression (<i>p</i> = 0.536) were not significantly different between the drug-eluting microsphere TACE and cisplatin TACE groups. However, the drug-eluting microsphere TACE group had significantly higher objective tumor regression rates in subgroups with Barcelona Clinic Liver Cancer (BCLC) stage C disease (<i>p</i> = 0.033) and a maximal tumor size larger than 5 cm (<i>p</i> = 0.011). After adjustment by propensity score matching, the rates of major complications, objective tumor response, and time to progression remained similar between the two groups. <b>CONCLUSION.</b> Both TACE with 30- to 60-μm drug-eluting microspheres and cisplatin TACE were safe and effective for treating unresectable HCC. In patients with BCLC stage C disease and patients with large (> 5 cm) HCCs, TACE with 30- to 60-μm drug-eluting micro-spheres may have a better chance of obtaining an objective tumor response than conventional TACE performed with the protocol used in this study.