Non selective beta-blockers prevent PHT-related complications occurrence in HCC patients with esophageal varices treated by TACE.

Introduction: . We aimed to investigate the parameters associated with portal hypertension (PHT)-related complications occurrence in hepatocellular carcinoma (HCC) patients treated by transarterial chemoembolization (TACE), with a focus on non-selective beta blockers (NSBBs) due to their impact on preventing liver decompensation.

Methods: . We included all patients with HCC for whom endoscopy was available the day of first TACE (2013-2023). The occurrence of PHT-related complications was defined as the appearance of ascites, acute variceal bleeding or hepatic encephalopathy (HE) post-TACE treatment and prior to HCC progression. Inappropriate treatment by NSBBs was defined by the lack of NSBBs in patients with small/large esophageal varices (EV).

Results: . 109 patients were included (age 67 years, 80% male) and 65% had EV. No NSBBs prescription despite indication was observed in 32% and 81% of patients with large and small size EV, respectively. Median progression free survival and overall survival were 10 and 23 months, respectively, and 27% of patients underwent LT. During the follow-up, 20 patients presented PHT-related complications with an incidence of 18% at 12months (90% with EV,67% not treated by NSBB while indicated). Among them, 11 presented HCC progression, 2 were transplanted and 78% presented liver decompensation that impaired the access to further HCC treatment. In multivariate analysis, a history of HE (HR=55.39,95%CI[7.42-413.26]) and inappropriate NSBBs treatment (HR=4.16,95%CI[1.45-11.81]) were associated with PHT-related complications occurrence.

Conclusion: . The lack of NSBBs was independently associated with PHT-related complications after TACE, precluding access to further HCC treatment in 78% of patients with HCC progression. Appropriate screening and PHT prophylaxis are needed in HCC patients who undergo TACE to improve their outcomes.