Transcatheter Arterial Chemoembolization (TACE) in Hepatocellular Carcinoma (HCC): The Role of Angio

April 5, 2008

The American Journal of Gastroenterology 103 (4) , 914–921

doi:10.1111/j.1572-0241.2007.01712.x

Abstract

Transcatheter Arterial Chemoembolization (TACE) in Hepatocellular Carcinoma

(HCC): The Role of Angiogenesis and Invasiveness

, M.D.22Istituto Oncologico Veneto, Padova, Italy, Chiara

Cristofori, M.D.11Dipartimento di Scienze Chirurgiche e Gastroenterologiche,

Università degli Studi di Padova, Padova, Italy, Romilda Cardin,

Ph.D.11Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università

degli Studi di Padova, Padova, Italy, Giorgio Pivetta, M.D.33Radiologia, Azienda

Ospedaliera di Padova, Padova, Italy, o Ragazzi, M.D.33Radiologia, Azienda

Ospedaliera di Padova, Padova, Italy, Baldan, M.D.11Dipartimento di Scienze

Chirurgiche e Gastroenterologiche, Università degli Studi di Padova, Padova,

Italy, Girardi, M.D.11Dipartimento di Scienze Chirurgiche e

Gastroenterologiche, Università degli Studi di Padova, Padova, Italy, Umberto

Cillo, M.D.41Dipartimento di Scienze Chirurgiche e Gastroenterologiche,

Università degli Studi di Padova, Padova, Italy, Patrizia Burra,

M.D.11Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università

degli Studi di Padova, Padova, Italy, Giacomin, M.D.11Dipartimento di

Scienze Chirurgiche e Gastroenterologiche, Università degli Studi di Padova,

Padova, Italy, and Fabio Farinati, M.D.11Dipartimento di Scienze Chirurgiche e

Gastroenterologiche, Università degli Studi di Padova, Padova,

Italy1Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università

degli Studi di Padova, Padova, Italy; 2Istituto Oncologico Veneto, Padova,

Italy; 3Radiologia, Azienda Ospedaliera di Padova, Padova, Italy; and 4Clinica

Chirurgica I, Università di Padova, Padova, Italy

Reprint requests and correspondence: Fabio Farinati, Dipartimento di Scienze

Chirurgiche e Gastroenterologiche—Sezione di Gastroenterologia, Policlinico

Universitario, Via Giustiniani 2, 35128 Padova, Italy.

(Am J Gastroenterol 2008;103:914–921)

Abstract

OBJECTIVE: Although transcatheter arterial chemoembolization (TACE) is

effective in hepatocellular carcinoma (HCC), it is not considered a curative

procedure. Among the factors potentially interfering with its effectiveness is a

hypothetical neoangiogenic reaction due to ischemia. In our study, we evaluated

the changes in the levels of two angiogenic factors (vascular endothelial growth

factor [VEGF] and basic fibroblast growth factor [b-FGF]) and one parameter of

invasiveness (urokinase-type plasminogen activator [uPA]) in patients treated

with TACE.

METHODS: Three blood samples were provided from 71 HCC patients undergoing

TACE: before TACE (t0), after 3 days (t1), and after 4 wk, when they had spiral

computed tomography (sCT) scanning (t2). The referring radiologists blindly

evaluated tumor burden and vascularization at t0 and residual activity at t2.

The choice of TACE as treatment was based on the American Association for the

Study of Liver Diseases (AASLD) guidelines.

RESULTS: Complete response at sCT was recorded in 27% of patients; mean

survival was 35 months (confidence interval [CI] 31–40) and the 4-yr survival

was 57%. VEGF levels were significantly correlated with the number of nodes and

were higher in nonresponders at t2 (P = 0.01); below-median VEGF levels

predicted a longer survival (P = 0.008). b-FGF correlated with VEGF, tumor size,

vascularization, and residual activity, showing a borderline correlation with

survival. uPA correlated with tumor size and VEGF. VEGF was singled out in the

multivariate analysis as an independent predictor of survival.

CONCLUSIONS: When TACE is not totally effective, it may induce a significant

neoangiogenetic reaction, as suggested by an increase in VEGF and b-FGF

following treatment; this affects patient survival. VEGF emerges as the most

reliable prognostic parameter, so it could be measured for judging TACE

efficacy. Finally, antiangiogenic drugs may be indicated in TACE-treated HCC.

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1572-0241.2007.01712.x

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April 5, 2008