Thermal Ablation and Transarterial Chemoembolization are Characterized by Changing Dynamics of Circulating MicroRNAs.

PURPOSE: To determine whether the levels of circulating microRNAs (miRNAs) are altered in patients undergoing thermal ablation and chemoembolization and whether these changes are predictive of a clinical outcome. MATERIAL AND METHODS: This prospective study consisted of 43 patients diagnosed with hepatocellular carcinoma (n = 15) and intrahepatic colorectal cancer metastases (n = 28) treated with thermal ablation (n = 23; radiofrequency [n = 6] or microwave [n = 19]), chemoembolization using drug-eluting embolics (n = 18), or both (n = 2). Four blood samples (immediately before the intervention and 60-90 minutes, 24 hours, and 7 days after the intervention) were taken to measure the plasma concentrations of miRNAs related to hypoxia (miR-21 and miR-210), liver injury (miR-122), epithelial-mesenchymal transition (miR-200a), and apoptosis (miR-34a) using miRNA-specific TaqMan assays and quantitative real-time polymerase chain reaction. Tumor burden and treatment response at 3 months were evaluated using the modified response evaluation criteria in solid tumors. The miRNA results were compared with clinical outcomes (Mann-Whitney U test, Wilcoxon matched-pair test). RESULTS: Dynamic changes in the circulating miRNA levels were observed following both the interventions. For thermal ablation, significant increases in miR-21, miR-210, miR-122, miR-200a, and miR-34a concentrations peaked 60-90 minutes after the intervention (P < .01). However, for transarterial chemoembolization, maximum increases in the miRNA concentrations were observed at 24 hours after the intervention for miR-21, miR-210, miR-122, miR-200a, and miR-34a (P < .05). The increased concentrations of the circulating miRNAs were followed by a subsequent decline to baseline by 7 days. For the thermal ablation (but not chemoembolization) patients, elevations in the miR-210 and miR-200a levels were associated with early progressive disease at 3 months (P = .040 and P = .012, respectively). CONCLUSIONS: Increased but dynamic levels of circulating miRNAs are present following interventional oncologic procedures and may prove useful as biomarkers for the monitoring of clinical outcomes.

Prognostic Survival Factors of Hepatocellular Carcinoma Treated with Transarterial Chemoembolization.

PURPOSE: Identification of prognostic survival factors of hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) in a single center in 2005-2018. BACKGROUND: Transarterial chemoembolization in hepatocellular carcinoma is indicated in Barcelona Liver Cancer Clinic (BLCC) stage B. This stage includes a very large group of patients unsuitable for curative treatment, who are in a good clinical condition and do not show extra-hepatic spread. The aim of this retrospective analysis is to identify factors influencing patient survival and to divide the patients into subgroups based on these risk factors. MATERIALS AND METHODS: All patients with HCC indicated for TACE in complex oncological center in 2005-2018 were included in the analysis. The survival rates from the 1st TACE were evaluated in relation to HCC on computed tomography/magnetic resonance prior to the 1st TACE (size of the biggest lesion, single/multiple lesions, unilobar/bilobar involvement), presence and severity of liver disease (cirrhosis, Child-Pugh, portal vein thrombosis) and a combination of other invasive treatment (resection, percutaneous ablation) (single and multivariate analysis). The survival of HCC patients was compared according to the year of the dia-gnosis and the year of the 1st TACE (log-rank test). RESULTS: Out of 382 patients, 157 (29 women) of them were treated with TACE (540 TACEs in total, median 3 TACEs per patient). The most important risk factors for survival were the presence of portal vein thrombosis (hazard ratio (HR) = 3.279), bilobar involvement (HR = 2.257), lesion size (HR = 1.125/cm) and Child-Pugh B in chronic liver disease (HR = 1.922). Based on these risk factors, the patients were divided into 3 prognostic groups with different median survival (52.1 vs. 21.5 vs. 9.0 months). CONCLUSION: Based on the retrospective analysis, predictive factors of HCC survival after TACE were identified and the patients were divided into 3 prognostic groups based on these factors.