Portal hypertension increases the risk of hepatic decompensation after 90Yttrium radioembolization in patients with hepatocellular carcinoma: a cohort study.
hepatocellular carcinoma
portal hypertension
transarterial radioembolization
Journal
Therapeutic advances in gastroenterology
ISSN: 1756-283X
Titre abrégé: Therap Adv Gastroenterol
Pays: England
ID NLM: 101478893
Informations de publication
Date de publication:
2023
2023
Historique:
received:
08
06
2023
accepted:
21
09
2023
medline:
3
11
2023
pubmed:
3
11
2023
entrez:
3
11
2023
Statut:
epublish
Résumé
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. We aimed to investigate the impact of TARE on the incidence of decompensation events and its predictive factors. In all, 63 consecutive patients treated with TARE between February 2012 and December 2018 were retrospectively included. 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. 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; 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.
Sections du résumé
Background
UNASSIGNED
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
UNASSIGNED
We aimed to investigate the impact of TARE on the incidence of decompensation events and its predictive factors.
Design
UNASSIGNED
In all, 63 consecutive patients treated with TARE between February 2012 and December 2018 were retrospectively included.
Methods
UNASSIGNED
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
UNASSIGNED
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;
Conclusion
UNASSIGNED
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.
Identifiants
pubmed: 37920686
doi: 10.1177/17562848231206995
pii: 10.1177_17562848231206995
pmc: PMC10619355
doi:
Types de publication
Journal Article
Langues
eng
Pagination
17562848231206995Informations de copyright
© The Author(s), 2023.
Références
J Hepatol. 2022 Apr;76(4):959-974
pubmed: 35120736
J Hepatol. 2020 Apr;72(4):718-724
pubmed: 31836549
J Hepatol. 2018 Aug;69(2):406-460
pubmed: 29653741
J Vasc Interv Radiol. 2018 Jun;29(6):858-865
pubmed: 29724520
J Hepatol. 2018 Apr;68(4):724-732
pubmed: 29331342
HPB (Oxford). 2016 Jan;18(1):7-12
pubmed: 26776845
J Vasc Interv Radiol. 2011 Dec;22(12):1706-13
pubmed: 21937241
J Hepatol. 2022 Mar;76(3):681-693
pubmed: 34801630
Hepatology. 2021 Nov;74(5):2342-2352
pubmed: 33739462
J Hepatol. 2021 Dec;75(6):1387-1396
pubmed: 34454995
Clin Radiol. 2014 Feb;69(2):172-8
pubmed: 24209871
Ann Surg Oncol. 2013 Aug;20(8):2518-25
pubmed: 23494107
Liver Int. 2015 Feb;35(2):620-6
pubmed: 24930619
Cardiovasc Intervent Radiol. 2012 Oct;35(5):1109-18
pubmed: 22037709
Eur J Nucl Med Mol Imaging. 2021 Sep;48(10):3048-3057
pubmed: 33674893
Am J Clin Oncol. 1982 Dec;5(6):649-55
pubmed: 7165009
Eur J Nucl Med Mol Imaging. 2011 Jul;38(7):1393-406
pubmed: 21494856
Lancet Oncol. 2017 Dec;18(12):1624-1636
pubmed: 29107679
Eur J Nucl Med Mol Imaging. 2020 Apr;47(4):816-827
pubmed: 31741021
J Vasc Interv Radiol. 2017 Oct;28(10):1432-1437.e3
pubmed: 28757285
Hepatology. 2014 May;59(5):1864-73
pubmed: 24259442
Eur J Nucl Med Mol Imaging. 2018 Mar;45(3):392-401
pubmed: 29177870
J Hepatol. 2006 Jan;44(1):217-31
pubmed: 16298014
Gastroenterology. 2007 Aug;133(2):481-8
pubmed: 17681169
J Clin Epidemiol. 2008 Apr;61(4):344-9
pubmed: 18313558
J Comput Assist Tomogr. 2016 May-Jun;40(3):478-84
pubmed: 26966951
Hepatology. 2015 Feb;61(2):526-36
pubmed: 25212123
Gastroenterology. 2018 May;154(6):1706-1718.e1
pubmed: 29425931
J Hepatol. 2018 Jul;69(1):182-236
pubmed: 29628281
PLoS One. 2017 Jul 14;12(7):e0181488
pubmed: 28708902
Cardiovasc Intervent Radiol. 2014 Aug;37(4):1009-17
pubmed: 24091754
Hepatology. 2017 Sep;66(3):969-982
pubmed: 28407278
Eur J Nucl Med Mol Imaging. 2015 Oct;42(11):1718-1738
pubmed: 26112387
Hepatology. 2016 Dec;64(6):2173-2184
pubmed: 27639071
Cancers (Basel). 2021 Jul 28;13(15):
pubmed: 34359695
N Engl J Med. 2008 Sep 4;359(10):1018-26
pubmed: 18768945
Lancet Gastroenterol Hepatol. 2021 Jan;6(1):17-29
pubmed: 33166497
J Hepatocell Carcinoma. 2021 Jul 30;8:861-870
pubmed: 34368021