Occurrence, Related Factors and Prognostic Value of Vascular Lake in Hepatocellular Carcinoma Patients Treated with Drug-Eluting Bead Transarterial Chemoembolization

Hao Li,* Manzhou Wang,* Pengfei Chen, Fangzheng Li, Donglin Kuang, Xinwei Han, Jianzhuang Ren, Xuhua Duan Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xuhua Duan; Jianzhuang RenDepartment of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, 450052, Henan Province, People’s Republic of ChinaTel +86-371-66278081Fax +86-371-66278082Email bozhuanglu18015@163.com; jizong3610938@163.comPurpose: The present study aimed to assess the prevalence of vascular lake (VL), its associated factors and correlation with prognosis in hepatocellular carcinoma (HCC) patients treated with drug-eluting bead transarterial chemoembolization (DEB-TACE).&#x00A0Patients and Methods:  A total of 286 primary HCC patients (with 384 treated nodules) receiving DEB-TACE treatment were recruited, and their clinical characteristics were documented. The occurrence of VL was recorded, and treatment responses were assessed according to the modified response evaluation criteria in solid tumor (mRECIST).In terms of treatment response, the total response status (including CR, PR, SD and PD), objective response rate (ORR) and disease control rate (DCR) were elevated in VL patients compared to non-VL patients as well as in VL nodules compared to non-VL nodules. Liver function indexes and adverse events were assessed. Progression-free survival (PFS) and overall survival (OS) were evaluated with the last follow-up date of March 2020.&#x00A0Results: The patient-based and nodule-based VL occurrence rates were 17.1% and 16.4%, respectively. Larger tumor size, pseudocapsules and smaller bead size were independently associated with VL occurrence. PFS and OS were more prolonged in VL patients than in non-VL patients, and VL independently correlated with better PFS and OS. For liver function, the liver function indexes before and after DEB-TACE were of no difference between VL patients and non-VL patients. Additionally, the incidences of adverse events were similar between VL patients and non-VL patients.Conclusion:  VL occurs in 17.1% of HCC patients treated with DEB-TACE, and it is correlated with larger tumor size, pseudocapsule, smaller bead size, more favorable treatment response and better survival.Keywords: hepatocellular carcinoma, drug-eluting bead transarterial chemoembolization, vascular lake, related factors, efficacy, safety