TIPS 可改善 HCC 合并症状性门脉高压患者的预后：多中心经验。
TIPS improves outcomes in patients with HCC and symptomatic portal hypertension: a multi-institution experience.
机构信息
Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China.
Department of Minimally Invasive & Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.
出版信息
Cancer Imaging. 2022 Feb 19;22(1):13. doi: 10.1186/s40644-022-00451-9.
BACKGROUND
Hepatocellular carcinoma (HCC) with symptomatic portal hypertension (SPH) has poor prognosis. A transjugular intrahepatic portosystemic shunt (TIPS) relieves SPH, but its application in HCC remains unclear. We evaluated TIPS efficacy in patients with HCC and SPH.
METHODS
Pre- and post-TIPS Child-pugh(C-P) scores and stages in 123 HCC patients with SPH from three centers were compared. The impact of postoperative C-P stage indicators on overall survival (OS) was explored.
RESULTS
Post-TIPS responses to SPH included complete response (CR) (92 [74.8%]), partial response (PR) (23 [18.7%]), and nonresponse (NR) (8 [6.5%]). The control (proportion of CR and PR) for SPH was 93.5%. Median C-P scores pre-TIPS and at one month post-TIPS were 8 (IQR 6-9) and 7 (IQR 6-8), respectively (P < 0.001). Forty-one (33.3%) patients had C-P downstaging; 73 (59.3%) had lowered C-P scores; and 73 (59.3%) received intrahepatic local therapy post-TIPS. The median OS was 10.7 (1.1-55.2) months. Among the five indicators of C-P stage, lower post-TIPS ascites grading [(0/1)/(2/3); P = 0.014, HR = 0.31 (95% CI: 0.12-0.79)] and bilirubin [< 34/ ≥ 34 µmol/L; P = 0.022, HR = 0.47 (95% CI: 0.23-0.82)] and prothrombin time prolongation < 6 s [< 6/ ≥ 6 s; P = 0.001, HR = 0.17 (95% CI: 0.06-0.47)] were independent protective indicators of OS. These three indicators were included in the nomogram model to predict survival probabilities.
CONCLUSIONS
TIPS is safe and effective for HCC with SPH. This procedure can relieve the symptoms, enable subsequent antitumor therapy, and bring survival benefits, possibly through improved liver function by reducing C-P stage.
背景
伴有症状性门静脉高压症（SPH）的肝细胞癌（HCC）预后较差。经颈静脉肝内门体分流术（TIPS）可缓解 SPH，但在 HCC 中的应用尚不清楚。我们评估了 TIPS 在 HCC 伴 SPH 患者中的疗效。
方法
比较了来自三个中心的 123 例 HCC 伴 SPH 患者 TIPS 前后的 Child-pugh（C-P）评分和分期。探讨了术后 C-P 分期指标对总生存期（OS）的影响。
结果
SPH 的 TIPS 后反应包括完全缓解（CR）（92[74.8%]）、部分缓解（PR）（23[18.7%]）和无反应（NR）（8[6.5%]）。SPH 的对照（CR 和 PR 的比例）为 93.5%。TIPS 前和 TIPS 后一个月的中位 C-P 评分分别为 8（IQR 6-9）和 7（IQR 6-8）（P<0.001）。41（33.3%）例患者 C-P 降级；73（59.3%）例患者 C-P 评分降低；73（59.3%）例患者在 TIPS 后接受了肝内局部治疗。中位 OS 为 10.7（1.1-55.2）个月。在 C-P 分期的五个指标中，较低的 TIPS 后腹水分级[（0/1）/（2/3）；P=0.014，HR=0.31（95%CI：0.12-0.79）]和胆红素[<34/≥34µmol/L；P=0.022，HR=0.47（95%CI：0.23-0.82）]和凝血酶原时间延长[<6/≥6s；P=0.001，HR=0.17（95%CI：0.06-0.47）]是 OS 的独立保护指标。这三个指标被纳入预测生存概率的列线图模型中。
结论
TIPS 治疗 HCC 伴 SPH 安全有效。该方法可缓解症状，为后续抗肿瘤治疗提供便利，并带来生存获益，可能通过降低 C-P 分期改善肝功能。
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