Portal hypertension increases the risk of hepatic decompensation after 90Yttrium radioembolization in patients with hepatocellular carcinoma: a cohort study.

IF 3.9 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Therapeutic Advances in Gastroenterology Pub Date : 2023-10-31 eCollection Date: 2023-01-01 DOI:10.1177/17562848231206995

Laura Carrión, Ana Clemente-Sánchez, Laura Márquez-Pérez, Javier Orcajo-Rincón, Amanda Rotger, Enrique Ramón-Botella, Manuel González-Leyte, Miguel Echenagusía-Boyra, Arturo Luis Colón, Laura Reguera-Berenguer, Rafael Bañares, Diego Rincón, Ana Matilla-Peña

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Abstract

Background: Transarterial radioembolization (TARE) is increasingly used in patients with hepatocellular carcinoma (HCC). This treatment can induce or impair portal hypertension, leading to hepatic decompensation. TARE also promotes changes in liver and spleen volumes that may modify therapeutic decisions and outcomes after therapy.

Objectives: We aimed to investigate the impact of TARE on the incidence of decompensation events and its predictive factors.

Design: In all, 63 consecutive patients treated with TARE between February 2012 and December 2018 were retrospectively included.

Methods: We assessed clinical (including Barcelona Clinic Liver Cancer stage, portal hypertension assessment, and liver decompensation), laboratory parameters, and liver and spleen volumes before and 6 and 12 weeks after treatment. A multivariate analysis was performed.

Results: In total, 18 out of 63 (28.6%) patients had liver decompensation (ascites, variceal bleeding, jaundice, or encephalopathy) within the first 3 months after therapy, not associated with tumor progression. Clinically significant portal hypertension (CSPH) and bilobar treatment independently predicted the development of liver decompensation after TARE. A significant volume increase in the non-treated hemi-liver was observed only in patients with unilobar treatment (median volume increase of 20.2% in patients with right lobe TARE; p = 0.007), especially in those without CSPH. Spleen volume also increased after TARE (median volume increase of 16.1%; p = 0.0001) and was associated with worsening liver function scores and decreased platelet count.

Conclusion: Bilobar TARE and CSPH may be associated with an increased risk of liver decompensation in patients with intermediate or advanced HCC. A careful assessment considering these variables before therapy may optimize candidate selection and improve treatment planning.

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门静脉高压增加肝细胞癌患者90Y放射性栓塞后肝功能失代偿的风险：一项队列研究。

背景：经动脉放射栓塞（TARE）越来越多地用于肝细胞癌（HCC）患者。这种治疗可诱发或损害门静脉高压，导致肝脏失代偿。TARE还促进肝脏和脾脏体积的变化，这可能会改变治疗决定和治疗后的结果。目的：我们旨在研究TARE对失代偿事件发生率的影响及其预测因素。设计：回顾性纳入2012年2月至2018年12月期间连续63例接受TARE治疗的患者。方法：我们评估了临床（包括巴塞罗那临床癌症分期、门脉高压评估和肝失代偿）、实验室参数以及6和12年前的肝脾容量治疗后数周。进行了多变量分析。结果：总的来说，63名患者中有18名（28.6%）在前3天内出现肝脏失代偿（腹水、静脉曲张破裂出血、黄疸或脑病）治疗后数月，与肿瘤进展无关。具有临床意义的门静脉高压症（CSPH）和比洛巴治疗独立预测了TARE后肝脏失代偿的发展。仅在单叶治疗的患者中观察到未治疗的半肝体积显著增加（右叶TARE患者的中位体积增加20.2%；p = 0.007），特别是在没有CSPH的那些中。TARE后脾脏体积也增加（中位体积增加16.1%；p = 0.0001），并且与肝功能评分恶化和血小板计数下降有关。结论：在中晚期HCC患者中，Bilobar TARE和CSPH可能与肝失代偿风险增加有关。在治疗前仔细评估这些变量可以优化候选药物的选择并改进治疗计划。

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来源期刊

Therapeutic Advances in Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.70

自引率

2.40%

发文量

103

审稿时长

15 weeks

期刊介绍： Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area. The editors welcome original research articles across all areas of gastroenterology and hepatology. The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.