AUTHOR=Tao Ziwen , Ruan Yuying , Peng Zhi , Zhang Kai , Gao Yanjing 

TITLE=Transarterial Chemoembolization Combined With Endoscopic Therapy Is Beneficial for Unresectable Hepatocellular Carcinoma With Esophagogastric Varices

JOURNAL=Frontiers in Oncology

VOLUME=11

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.783574

DOI=10.3389/fonc.2021.783574

ISSN=2234-943X

ABSTRACT=<sec><title>Background</title><p>The efficacy of transarterial chemoembolization (TACE) combined with endoscopic therapy for unresectable hepatocellular carcinoma with esophagogastric varices remains unclear.</p></sec><sec><title>Methods</title><p>The study has been registered on ClinicalTrials.gov with the number NCT05017922 (<uri xlink:href="https://register.clinicaltrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">https://register.clinicaltrials.gov</uri>). Eligible patients were divided into combined group (received TACE plus endoscopic therapy) and control group (only received TACE). The occurrence of death and bleeding episodes during the follow-up was recorded. Kaplan–Meier analysis was used to compare outcomes between the two groups. Cox proportional hazard model was used to determine independent predictors for the survival.</p></sec><sec><title>Results</title><p>Eighty-nine patients were included, 42 in the combined group, others in the control group. During the follow-up, 51 patients died, the 1-year, 2-year, and 3-year survival rates were 64.9%, 45.5%, and 34.5%. The cumulative survival was significantly higher in the combined group than in the control group (<italic>p</italic> = 0.027); the 1-year, 2-year, and 3-year survival rates were 75.5%, 55.9%, 43.8% and 55.0%, 35.9%, 26.6%, respectively. Forty-four patients experienced bleeding, the bleeding rate was significantly higher in the control group than in the combined group (77.4% vs. 56.8%, <italic>p</italic> = 0.016). Multivariate analysis showed that treatment, hemoglobin, portal vein tumor thrombosis, and aspartate aminotransferase were independent predictors for overall survival; the first three factors were also independent predictors for bleeding-free survival. Patients who received primary prophylaxis had longer overall survival (<italic>p</italic> = 0.042) and bleeding-free survival (<italic>p</italic> = 0.029) than those who received secondary prophylaxis.</p></sec><sec><title>Conclusions</title><p>TACE combined with endoscopic therapy significantly improved survival and reduced bleeding rates in unresectable hepatocellular carcinoma with esophagogastric varices patients. Portal vein tumor thrombosis was a strong negative prognostic factor for both overall survival and bleeding-free survival. Primary prophylaxis improved survival benefits compared with secondary prophylaxis.</p></sec>