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Tesi etd-10112019-171749


Thesis type
Tesi di specializzazione (4 anni)
Author
ACQUAFREDDA, FABRIZIO
URN
etd-10112019-171749
Title
DEB-TACE versus c-TACE as first treatment for unresectable hepatocellular carcinoma: a retrospective cost-utility analysis
Struttura
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
RADIODIAGNOSTICA
Commissione
relatore Prof. Caramella, Davide
relatore Dott.ssa Bargellini, Irene
Parole chiave
  • HCC
  • Lipiodol-TACE
  • unresectable hepatocellular carcinoma
  • c-TACE
  • DEB-TACE
Data inizio appello
02/11/2019;
Consultabilità
secretata d'ufficio
Data di rilascio
02/11/2022
Riassunto analitico
Purpose of this retrospective study was to evaluate the peri- and post-procedural costs and clinical outcome of DEB-TACE compared to c-TACE in patients with unresectable HCC treated with TACE as first treatment in a period from 2006 to 2013. The primary endpoint was the cost comparison of the two TACE techniques, considering the costs of the procedure and the costs of follow-up. The secondary endpoint was the comparison of the results of the two TACE techniques, in terms of overall survival and time to tumor progression .
The final study population consisted of 327 patients; 160 treated with c-TACE and 167 with DEB-TACE. In the entire population, DEB-TACE resulted to be associated with lower complications, better tumor response and longer overall survival. However, most of these differences are related to the significant differences in baseline clinical characteristics. Considering this, propensity score matching was needed for a better interpretation of the results. After matching, 101 patients in each treatment group were selected. Our data confirm a favourable toxicity profile of DEB-TACE compared to c-TACE, as demonstrated by the lower incidence of adverse events and shorter hospitalization time.
As reported, there were no differences in radiological response and overall survival comparing the matched treatment groups, although a trend towards longer time to tumor progression and longer survival was observed after DEB-TACE. If this trend could lead to a statistically significant difference when analysing larger series of patients is still a matter of debate.
Of interest, in patients achieving target tumor complete response at 1 month, time to local tumor progression proved to be significantly (P=0.001) longer after DEB-TACE compared to c-TACE. This resulted in lower number of re-treatments during follow-up (1.6 vs 0.75, P= 0.01), although, ultimately, overall tumor progression and survival did not differ significantly (P>0.05).
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