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. 2019 Jul;7(6):850-858.
doi: 10.1177/2050640619840199. Epub 2019 Mar 21.

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

Bernhard Scheiner  1   2   3 , Gregor Ulbrich  1 , Mattias Mandorfer  1   3 , Thomas Reiberger  1   3 , Christian Müller  1   2 , Fredrik Waneck  4 , Michael Trauner  1 , Claus Kölblinger  4   5 , Arnulf Ferlitsch  1   6 , Wolfgang Sieghart  1   2 , Markus Peck-Radosavljevic  1   7 , Matthias Pinter  1   2
Affiliations

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

Bernhard Scheiner et al. United European Gastroenterol J. 2019 Jul.

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.

Keywords: Hepatic venous pressure gradient; hepatocellular carcinoma; portal hypertension; transarterial chemoembolization.

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Figures

Figure 1.
Figure 1.
Patient flowchart. HVPG: hepatic venous pressure gradient; NSBB, nonselective beta-blocker; TACE: transarterial chemoembolization.
Figure 2.
Figure 2.
Comparison of HVPG value at baseline (before first TACE) and (a) shortly after the first TACE (“acute effects group”), (b) after two months and (c) after six months. HVPG: hepatic venous pressure gradient; TACE: transarterial chemoembolization.
Figure 3.
Figure 3.
Correlation between changes in HVPG and changes in MELD score between baseline (pre-TACE) and month 6 (after repeated TACE). Abbreviations: Δ HVPG: delta hepatic venous pressure gradient; Δ MELD: delta model of end-stage liver disease.
Figure 4.
Figure 4.
Impact of clinically significant portal hypertension at baseline on survival. Abbreviations: HVPG: hepatic venous pressure gradient.
See this image and copyright information in PMC

References

    1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87–108. - PubMed
    1. Akinyemiju T, Abera S, et al. Global Burden of Disease Liver Cancer Collaboration. The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level: Results from the Global Burden of Disease Study 2015. JAMA Oncol 2017; 3: 1683–1691. - PMC - PubMed
    1. Pinter M, Peck-Radosavljevic M. Review article: Systemic treatment of hepatocellular carcinoma. Aliment Pharmacol Ther 2018; 48: 598–609. - PMC - PubMed
    1. Sieghart W, Pinter M, Hucke F, et al. Single determination of C-reactive protein at the time of diagnosis predicts long-term outcome of patients with hepatocellular carcinoma. Hepatology 2013; 57: 2224–2234. - PubMed
    1. Scheiner B, Kirstein MM, Popp S, et al. Association of platelet count and mean platelet volume with overall survival in patients with cirrhosis and unresectable hepatocellular carcinoma. Liver Cancer.. Epub ahead of print 22 June 2018. DOI:10.1159/000489833. - PMC - PubMed

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