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Short- and long-term effects of transarterial chemoembolization on portal hypertension in patients with hepatocellular carcinoma.

ABSTRACT: Background:Transarterial chemoembolization (TACE) affects hepatic perfusion, and might have an impact on portal pressure in patients with hepatocellular carcinoma (HCC). Objective:The objective of this article is to report the secondary outcome "hepatic hemodynamics" from the AVATACE trial, a prospective randomized, placebo-controlled trial on the efficacy of conventional TACE in combination with bevacizumab or placebo. Methods:Hepatic venous pressure gradient (HVPG) was measured at baseline (prior to first TACE), within nine days ("acute effects"), two months ("intermediate effects") and six months ("long-term effects") after the first TACE. Results:Of 28 patients with early-intermediate stage HCC, n?=?20 (71%) had clinically significant portal hypertension (CSPH, HVPG???10?mmHg) at baseline (median, 12 (interquartile range (IQR): 9-19)?mmHg). TACE had neither "acute effects" nor "intermediate effects" on HVPG. However, in 13 patients with available HVPG measurement at month 6, there was a significant increase in HVPG (median, 16 (IQR: 11-19)?mmHg) compared with baseline (median, 10 (IQR: 5-12)?mmHg; p?=?0.007). Portal hypertension-related complications occurred exclusively in patients with CSPH (8 (40%) vs 0). Conclusions:Repeated TACE was associated with a significant long-term increase in HVPG. This should be considered when deciding whether to continue with TACE or switch to systemic treatment, since CSPH drives the development of complications.

SUBMITTER: Scheiner B

PROVIDER: S-EPMC6620878 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Short- and long-term effects of transarterial chemoembolization on portal hypertension in patients with hepatocellular carcinoma.

Scheiner Bernhard B Ulbrich Gregor G Mandorfer Mattias M Reiberger Thomas T Müller Christian C Waneck Fredrik F Trauner Michael M Kölblinger Claus C Ferlitsch Arnulf A Sieghart Wolfgang W Peck-Radosavljevic Markus M Pinter Matthias M

United European gastroenterology journal 20190321 6

<h4>Background</h4>Transarterial chemoembolization (TACE) affects hepatic perfusion, and might have an impact on portal pressure in patients with hepatocellular carcinoma (HCC).<h4>Objective</h4>The objective of this article is to report the secondary outcome "hepatic hemodynamics" from the AVATACE trial, a prospective randomized, placebo-controlled trial on the efficacy of conventional TACE in combination with bevacizumab or placebo.<h4>Methods</h4>Hepatic venous pressure gradient (HVPG) was me ...[more]

PMID: 31316789

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Project description:BackgroundClinically evident portal hypertension (CEPH) was previously identified as a prognostic factor for patients with hepatocellular carcinoma (HCC). However, little is known about the prognostic influence of CEPH on the long-term outcome of patients with HCC undergoing transarterial chemoembolization (TACE), particularly in Western populations.ObjectivesThis study investigated the prevalence and prognostic influence of CEPH in a Western population of patients with HCC undergoing TACE.MethodsThis retrospective study included 349 treatment-naïve patients that received initial TACE treatment at our tertiary care center between January 2010 and November 2020. CEPH was defined as a combination of ascites, esophageal/gastric varices, splenomegaly and a low platelet count. We assessed the influence of CEPH and its defining factors on median overall survival (OS) in HCC patients. We compared the effects of CEPH to those of well-known prognostic factors.ResultsOf the 349 patients included, 304 (87.1%) patients had liver cirrhosis. CEPH was present in 241 (69.1%) patients. The median OS times were 10.6 months for patients with CEPH and 17.1 months for patients without CEPH (log rank p = 0.036). Median OS without a present surrogate was 17.1 months, while patients with one respectively more than two present CEPH surrogates had a median OS of 10.8 and 9.4 months (log rank p = 0.053). In multivariate analysis, CEPH was no significant risk factor for OS (p = 0.190). Of the CEPH-defining factors, only ascites reached significance in a univariate analysis.ConclusionCEPH was present in more than two thirds of the patients with HCC undergoing TACE in our cohort of Western patients. Patients with CEPH had a significantly impaired survival in univariate analysis. However, no significance was reached in multivariate analysis. Thus, when TACE treatment is deemed oncologically reasonable, patients should not be excluded from TACE treatment due to the presence of surrogates of portal hypertension alone.

Dataset Information

Short- and long-term effects of transarterial chemoembolization on portal hypertension in patients with hepatocellular carcinoma.

Publications

Short- and long-term effects of transarterial chemoembolization on portal hypertension in patients with hepatocellular carcinoma.

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