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Pinto E, Pelizzaro F, Cardin R, Battistel M, Palano G, Bertellini F, Kitenge MP, Peserico G, Farinati F, Russo FP. HIF-1α and VEGF as prognostic biomarkers in hepatocellular carcinoma patients treated with transarterial chemoembolization. Dig Liver Dis 2024; 56:872-879. [PMID: 37783655 DOI: 10.1016/j.dld.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/22/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Neoangiogenesis plays a crucial role in the progression of hepatocellular carcinoma (HCC), and concerns have been raised about the role of neoangiogenesis on the effectiveness of transarterial chemoembolization (TACE). AIM In this study, we aimed to evaluate Vascular Endothelial Growth Factor (VEGF) and Hypoxia-Inducible Factor-1α (HIF-1α) as circulating prognostic biomarkers in HCC patients treated with TACE. METHODS Blood samples were collected from 163 patients before (t0) and four weeks after TACE (t1). RESULTS Higher levels of VEGF after TACE were demonstrated (264.0 [78.7-450.8] vs. 278.6 [95.0-576.6] pg/mL; p < 0.0001). Responders to TACE had lower levels of VEGF than non-responders both at t0 (200.0 [58.9-415.8] vs. 406.6 [181.4-558.6] pg/mL; p = 0.006) and at t1 (257.3 [68.5-528.6] vs. 425.9 [245.2-808.3] pg/mL; p = 0.003), and in both groups there was an increase in VEGF compared to measurements before treatment (p = 0.001 and p = 0.005, respectively). VEGF was not associated with overall survival (OS), while patients with HIF-1α ≤ 0.49 ng/mL showed better prognosis (median OS 28.0 months [95% CI 19.7-36.3] vs. 17.0 months [95% CI 11.1-22.9]; p = 0.01). Moreover, HIF-1α was identified as an independent prognostic parameter. CONCLUSIONS VEGF and HIF-1α can be considered useful prognostic biomarkers in HCC patients treated with TACE.
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Affiliation(s)
- Elisa Pinto
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Filippo Pelizzaro
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Romilda Cardin
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Michele Battistel
- Radiology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Giorgio Palano
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Federica Bertellini
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Maria Piera Kitenge
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Giulia Peserico
- Gastroenterology Unit, Veneto Institute of Oncology (IOV), Padova, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, Padova, Italy.
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
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Anand S, Geschwind JF, Etezadi V, Nezami N. Lipiodol: from intrusion until exile from the tumor microenvironment. Oncoscience 2023; 10:34-35. [PMID: 37601621 PMCID: PMC10434996 DOI: 10.18632/oncoscience.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
| | | | | | - Nariman Nezami
- Correspondence to:Nariman Nezami, Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA; The Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, MD 20742, USA email:
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Langenbach MC, Vogl TJ, Buchinger A, Eichler K, Scholtz JE, Hammerstingl R, Gruber-Rouh T. CT-guided biopsies of unspecified suspect intrahepatic lesions: pre-procedure Lipiodol-marking improves the biopsy success rate. Radiol Oncol 2023; 57:158-167. [PMID: 37341197 DOI: 10.2478/raon-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/20/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND While computed tomography (CT)-guided liver biopsies are commonly performed using unenhanced images, contrast-enhanced images are beneficial for challenging puncture pathways and lesion locations. This study aimed to evaluate the accuracy of CT-guided biopsies for intrahepatic lesions using unenhanced, intravenous (IV)-enhanced, or intra-arterial Lipiodol-marked CT for lesion marking. PATIENTS AND METHODS Six-hundred-seven patients (men: 358 [59.0%], mean age 61 years; SD ±12.04) with suspect hepatic lesions and CT-guided liver biopsies were retrospectively evaluated. Successful biopsies were histopathological findings other than typical liver tissue or non-specific findings. Data was ascertained regarding the use of contrast medium for the biopsy-planning CT, unenhanced (group 1) vs. Lipiodol (group 2) vs. IV contrast (group 3). Technical success and influencing factors were insulated. Complications were noted. The results were analyzed using the Wilcoxon-Man-Whitney t-test, Chi-square test, and Spearman-Rho. RESULTS Overall lesion hitting rate was 73.1%, with significantly better rates using Lipiodol-marked lesions (79.3%) compared to group 1 (73.8%) and group 3 (65.2%) (p = 0.037). Smaller lesions (<20 mm diameter) benefited significantly from Lipiodol-marking with 71.2% successful biopsy rate compared to group 1 (65.5%) and group 3 (47.7%) (p = 0.021). Liver cirrhosis (p = 0.94) and entity of parenchymal lesions (p = 0.78) had no impact on the hitting rate between the groups. No major complications occurred during the interventions. CONCLUSIONS Pre-biopsy Lipiodol marking of suspect hepatic lesions significantly increases the lesion-hitting rate and is especially beneficial for biopsy of smaller targets below 20 mm diameter. Further, Lipiodol marking is superior to IV contrast for non-visible lesions in unenhanced CT. Target lesion entity has no impact on the hitting rate.
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Affiliation(s)
- Marcel Christian Langenbach
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas Joseph Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Amelie Buchinger
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Katrin Eichler
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Jan-Erik Scholtz
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Renate Hammerstingl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
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Fan XL, Wang YH, Chen YH, Chen BX, Cai JN, Yang JS, Sun X, Yan FR, He BS. Computed tomography texture analysis combined with preoperative clinical factors serve as a predictor of early efficacy of transcatheter arterial chemoembolization in hepatocellular carcinoma. Abdom Radiol (NY) 2023; 48:2008-2018. [PMID: 36943423 DOI: 10.1007/s00261-023-03868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/23/2023]
Abstract
AIM To investigate a pre-therapeutic radiomics nomogram to accurately predict hepatocellular carcinoma (HCC) lesion responses to transcatheter arterial chemoembolization (TACE). METHODS This retrospective study from January 2012 to 2022 included 92 TACE-treated patients who underwent liver contrast-enhanced CT scan 7 days before treatment, having complete clinical information. We extracted quantitative texture parameters and clinical factors for the largest tumors on the baseline arterial and portal venous phase CT images. An adaptive least absolute shrinkage and selection operator (LASSO)-penalized logistic regression identified independent predictors of tumor activity after TACE. RESULTS We fitted an adaptive LASSO regression model to narrow down the texture features and clinical risk factors of the tumor activity status. The selected texture features were used to construct radiomic scores (RadScore), which demonstrated superior performance in predicting tumor activity on both the training (area under the curve (AUC): 0.881, 95% CI: 0.799-0.963) and testing sets (AUC: 0.88, 95% CI: 0.726-1). A logistic regression-based nomogram was developed using RadScore and four selected clinical features. In the testing set, nomogram total points were significant predictors (P = 0.034), and the training set showed no departure from perfect fit (P = 0.833). Internal validation of the nomogram was obtained for the training (AUC: 0.91, 95% CI: 0.837-0.984) and testing (AUC: 0.889, 95% CI: 0.746-1) sets. CONCLUSION We propose a nomogram to predict the early response of HCC lesions to TACE treatment with high accuracy, which may serve as an additional criterion in multidisciplinary decision-making treatment.
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Affiliation(s)
- Xiao Le Fan
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People's Republic of China
| | - Yu Hang Wang
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 211198, People's Republic of China
| | - Yu Hao Chen
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People's Republic of China
| | - Bai Xu Chen
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People's Republic of China
| | - Jia Nan Cai
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People's Republic of China
| | - Ju Shun Yang
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People's Republic of China
| | - Xu Sun
- Université Paris Cité, 75013, Paris, France
| | - Fang Rong Yan
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 211198, People's Republic of China
| | - Bo Sheng He
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People's Republic of China.
- Clinical Medicine Research Center, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, People's Republic of China.
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Zhou H, Xie W, Guo A, Chen B, Hu S, Zheng M, Yu H, Tian H, Li L. Temperature sensitive nanogels for real-time imaging during transcatheter arterial embolization. Des Monomers Polym 2023; 26:31-44. [PMID: 36684709 PMCID: PMC9858417 DOI: 10.1080/15685551.2022.2164445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Several vascular embolization materials are commonly used in clinical practice, however, having application defects of varying degrees, such as poor intraoperative imaging and easy recanalization of embolized blood vessels, they are challenging for application during Transcatheter arterial embolization (TAE). Thus, an intraoperative visible vascular embolization material with good embolization effect and biocompatibility can improve transcatheter arterial embolization clinical efficacy to some extent. Our study aimed to synthesize a novel vascular embolization material that can achieve complete embolization of arterial trunks and peripheral vessels, namely poly (N-isopropyl acrylamide)-co-acrylic acid nanogel (NIPAM-co-AA). Iohexol 200 mg/mL was co-assembled with 7 wt% NIPAM-co-AA nanogel to create an intelligent thermosensitive radiopaque nanogel (INCA), which achieves a good intraoperative imaging effect and is convenient for transcatheter arterial bolus injection due to its good fluidity and temperature-sensitive sol-gel phase transition. The normal rabbit kidney embolism model further confirmed that INCA could effectively use Digital subtraction angiography (DSA) to achieve intraoperative imaging, and real-time monitoring of the embolization process could avoid mis-embolization and leakage. Meanwhile, in a 42-day study, INCA demonstrated an excellent embolization effect on the right renal artery of New Zealand white rabbits, with no vascular recanalization and ischemic necrosis and calcification remaining. As a result, this radiopaque thermosensitive nanogel has the potential to be an intelligent thermosensitive medical vascular embolization material, providing dual benefits in TAE intraoperative imaging and long-term postoperative embolization while effectively addressing the shortcomings and challenges of commonly used clinical vascular embolization agents.
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Affiliation(s)
- Hongfu Zhou
- School of Biomedical Engineering and Imaging, Xianning Medical College, Hubei University of Science and Technology, Xianning, PR China
| | - Wenjing Xie
- School of Pharmacy, Xianning Medical College, Hubei University of Science and Technology, Xianning, PR China
| | - Anran Guo
- School of Pharmacy, Xianning Medical College, Hubei University of Science and Technology, Xianning, PR China
| | - Bin Chen
- Department of Radiology, Xianning Central Hospital, the First Affiliated Hospital of Hubei University of Science and Technology, Xianning, P.R. China
| | - Sanming Hu
- School of Biomedical Engineering and Imaging, Xianning Medical College, Hubei University of Science and Technology, Xianning, PR China
| | - Min Zheng
- School of Biomedical Engineering and Imaging, Xianning Medical College, Hubei University of Science and Technology, Xianning, PR China
| | - Houqiang Yu
- Department of Mathematics and Statistics, Hubei University of Science and Technology, Xianning, PR China
| | - Hongan Tian
- Department of Radiology, Xianning Central Hospital, the First Affiliated Hospital of Hubei University of Science and Technology, Xianning, P.R. China,CONTACT Hongan Tian Department of Radiology, Xianning Central Hospital, the First Affiliated Hospital of Hubei University of Science and Technology, Xianning, PR China
| | - Ling Li
- School of Biomedical Engineering and Imaging, Xianning Medical College, Hubei University of Science and Technology, Xianning, PR China,Ling Li School of Biomedical Engineering and Imaging, Xianning Medical College, Hubei University of Science and Technology, Xianning, PR China
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Garg T, Shrigiriwar A, Habibollahi P, Cristescu M, Liddell RP, Chapiro J, Inglis P, Camacho JC, Nezami N. Intraarterial Therapies for the Management of Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:cancers14143351. [PMID: 35884412 PMCID: PMC9322128 DOI: 10.3390/cancers14143351] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 12/11/2022] Open
Abstract
Image-guided locoregional therapies play a crucial role in the management of patients with hepatocellular carcinoma (HCC). Transarterial therapies consist of a group of catheter-based treatments where embolic agents are delivered directly into the tumor via their supplying arteries. Some of the transarterial therapies available include bland embolization (TAE), transarterial chemoembolization (TACE), drug-eluting beads-transarterial chemoembolization (DEB-TACE), selective internal radioembolization therapy (SIRT), and hepatic artery infusion (HAI). This article provides a review of pre-procedural, intra-procedural, and post-procedural aspects of each therapy, along with a review of the literature. Newer embolotherapy options and future directions are also briefly discussed.
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Affiliation(s)
- Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (T.G.); (R.P.L.)
| | - Apurva Shrigiriwar
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| | - Peiman Habibollahi
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Mircea Cristescu
- Vascular and Interventional Radiology Division, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Robert P. Liddell
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (T.G.); (R.P.L.)
| | - Julius Chapiro
- Section of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06510, USA;
| | - Peter Inglis
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Juan C. Camacho
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
- Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, FL 34239, USA
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA
- Correspondence:
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Brown ZJ, Hewitt DB, Pawlik TM. Combination therapies plus transarterial chemoembolization in hepatocellular carcinoma: a snapshot of clinical trial progress. Expert Opin Investig Drugs 2021; 31:379-391. [PMID: 34788184 DOI: 10.1080/13543784.2022.2008355] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Unfortunately, some hepatocellular carcinoma (HCC) patients do not qualify for curative-intent treatments such as surgical resection or transplantation. Hence, locoregional treatments such as transarterial chemoembolization (TACE) remain instrumental in the treatment of HCC. Systemic therapy has improved over the past decade with the introduction of combination atezolizumab and bevacizumab as the new standard of care for advanced disease. These new therapies are currently under investigation in combination with TACE. AREA COVERED Combination therapies with TACE including systemic therapies, locoregional therapies, and immunotherapies are reviewed. EXPERT OPINION There has been limited progress in the management of advanced and intermediate HCC. Recent advances in the management of advanced disease with systemic therapy could be beneficial in combination with TACE for the treatment of intermediate stage disease. Immune based therapies are potentially beneficial in combination with TACE because TACE may produce increased antigen release and immune recognition.
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Affiliation(s)
- Zachary J Brown
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - D Brock Hewitt
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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