Efficacy and safety of conventional transarterial chemoembolization for hepatocellular carcinoma using a glass membrane emulsification device: comparison with a three-way stopcock

PURPOSE: To compare the efficacy and safety of conventional transarterial chemoembolization (cTACE) using a glass membrane emulsification device (GMD) versus a three-way stopcock (3WS) in treatment-naïve target lesions of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: We retrospectively analyzed 54 patients (73 target lesions) treated with GMD-cTACE and 39 patients (55 target lesions) treated with 3WS-cTACE. The emulsion consisted of 5 mL of Lipiodol and 2.5 mL of an iodinated nonionic contrast medium (iomeprol 300 mg I/mL) containing 50 mg of epirubicin. The primary endpoints were the direct treatment effect on target lesions, assessed by RECICL (2015). Recurrence-free survival (RFS), safety and modified albumin-bilirubin (mALBI) grade changes were evaluated as secondary endpoints. RESULTS: TE4 rates were 86.3% in the GMD group and 76.4% in the 3WS group (P = 0.15). The combined TE4 + TE3 rates were 93.2% versus 83.6%, respectively (P = 0.09). The median RFS of target lesions was 1,047 days in the GMD group and 362 days in the 3WS group. RFS of target lesions tended to be longer with GMD (log-rank P = 0.058), with 1-year RFS estimates of 0.740 (GMD) and 0.470 (3WS). Restricted mean survival time (RMST) up to 365 days favored GMD (difference, 40.2 days; 95% CI, - 0.8 to 81.1; P = 0.054). Changes in hepatic reserve were not significantly different between groups. CONCLUSION: GMD-cTACE showed numerically longer RFS of target lesions than 3WS-cTACE, with no significant between-group difference in hepatic function deterioration. Standardizing emulsion quality with GMD may improve the durability of local control in cTACE; larger prospective studies are warranted.