Improved Local Tumor Control and Survival Rates by Obtaining a 3D-Safety Margin in Superselective Transarterial Chemoembolization for Small Hepatocellular Carcinoma

  • Thanate Kattipatanapong
  • Hideyuki NishiofukuEmail author
  • Toshihiro Tanaka
  • Takeshi Sato
  • Tetsuya Masada
  • Shota Tatsumoto
  • Takeshi Matsumoto
  • Kimihiko Kichikawa
Clinical Investigation Interventional Oncology
Part of the following topical collections:
  1. Interventional Oncology



To investigate technical factors affecting local tumor control of small hepatocellular carcinoma (HCC) treated by superselective conventional transarterial chemoembolization (cTACE) using lipiodol and to compare prognoses between groups with and without these factors.

Materials and Methods

Sixty-three consecutive patients with 73 HCC nodules (diameter, 1–3 cm) treated by cTACE were retrospectively analyzed. A positive or a negative 3D-safety margin was defined as a ≥ 1-mm area of lipiodol accumulation or as a diameter of lipiodol accumulation < 1 mm in liver parenchyma surrounding the tumor using plain CT images obtained within a week after TACE. Uni- and multivariate analyses were performed to identify technical factors determining local tumor control rate. Subgroup analysis of survival rates in treatment-naïve patients was performed according to the detected factors.


In univariate analyses, three-dimensional (3D)-safety margin and portal vein visualization were associated with local tumor control rates. In multivariate analysis, only positive 3D-safety margin remained a significant contributor (p = 0.001). Two-year cumulative local disease-free survival rates with positive and negative 3D-safety margin were 82.8% and 19.3%, respectively (p = 0.001). In subgroup survival analysis of the 36 newly diagnosed patients, the 1-, 2-, 3-, 4-, and 5-year cumulative OS rates for patients with and without positive margins were 100% versus 100%, 96.4% versus 75.0%, 81.8% versus 62.5%, 74.4% versus 41.7%, and 47.0% versus 0%, respectively (median survival time; 57.6 months vs. 37.1, p = 0.047).


Obtaining a 3D-safety margin can suppress local tumor recurrence and prolong survival in superselective cTACE for small HCC.


Three-dimensional safety margin Transarterial chemoembolization Hepatocellular carcinoma Prognosis Recurrence Ethiodized oil 



Hepatocellular carcinoma


Conventional transarterial chemoembolization


Transarterial chemoembolization


Radiofrequency ablation


Three dimensional


Computed tomography


Magnetic resonance imaging


Multi-planar reconstruction


Local disease-free survival


Overall survival


Aspartate aminotransferase


Alanine aminotransferase


Total bilirubin


Compliance with Ethical Standards

Conflict of interest

The scientific guarantor of this publication is Prof. Kichikawa in Nara Medical University. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all patients in this study. Methodology: This paper is retrospective study at single institution. UMIN ID; R000029341.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  • Thanate Kattipatanapong
    • 1
    • 2
  • Hideyuki Nishiofuku
    • 1
    Email author
  • Toshihiro Tanaka
    • 1
  • Takeshi Sato
    • 1
  • Tetsuya Masada
    • 1
  • Shota Tatsumoto
    • 1
  • Takeshi Matsumoto
    • 1
  • Kimihiko Kichikawa
    • 1
  1. 1.Department of Radiology and IVR CenterNara Medical UniversityKashiharaThailand
  2. 2.Department of RadiologyChiang Mai UniversityChiang MaiThailand

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