Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangdong Province, Guangzhou, 510060, China.
Department of Endoscopy, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
Eur Radiol. 2022 Oct;32(10):6777-6787. doi: 10.1007/s00330-022-08705-7. Epub 2022 Apr 20.
Portal vein tumour thrombus (PVTT)-related symptomatic portal hypertension (SPH) leads to a poor prognosis in hepatocellular carcinoma (HCC) patients. A transjugular intrahepatic portosystemic shunt (TIPS) can effectively relieve SPH but its effect remains unclear in PVTT-related SPH. This study aimed to evaluate the clinical value of the TIPS procedure combined with sequential systemic therapy in advanced HCC patients with PVTT-related SPH.
After 1:1 propensity score matching (PSM), this retrospective study analysed 42 patients who underwent TIPS placement plus sequential systemic therapy (group A) and 42 patients who received only symptomatic and supportive treatment (group B). The evaluated outcomes were overall survival (OS) and SPH control rate. Cox proportional hazards regression analysis was used to compare OS in the two groups.
In group A, the technical success rate of the TIPS procedure was 95.2%, and no severe complications occurred. The rebleeding rates in group A and group B were 5.0% and 73.7%, respectively (p < 0.001), and the ascites control rates were 92.0% and 28.0%, respectively (p < 0.001). The median OS of group A was significantly better than that of group B (9.6 [95% CI: 7.1, 12.0] vs. 4.9 [95% CI: 3.9, 5.8], months, p < 0.001). Multivariable analysis showed that TIPS plus sequential systemic therapy (hazard ratio [HR] = 5.799; 95% CI: 3.177, 10.585; p < 0.001) was an independent prognostic factor related to OS. Additionally, PVTT degree (I+II) (p = 0.008), AFP ≤ 400 ng/ml (p = 0.003), and Child-Pugh class A (p = 0.046) were significant predictors of OS.
TIPS plus sequential systemic therapy is safe and feasible for treating advanced HCC with tumour thrombus-related SPH.
• Portal vein tumour thrombus (PVTT) is common in advanced hepatocellular carcinoma (HCC) and transforms compensated portal hypertension into symptomatic portal hypertension (SPH). • HCC patients with PVTT-related SPH have a very poor prognosis, and there are no effective treatments recommended by the guidelines. • Therefore, a treatment strategy that utilises a transjugular intrahepatic portosystemic shunt (TIPS) to manage SPH combined with sequential systemic therapy in advanced HCC patients is explored in this study for its feasibility and clinical value. This research can fill the gap in current research data to provide clinically meaningful treatment options.
门静脉癌栓（PVTT）相关的症状性门静脉高压（SPH）可导致肝细胞癌（HCC）患者预后不良。经颈静脉肝内门体分流术（TIPS）可有效缓解 SPH，但在 PVTT 相关 SPH 中的效果仍不清楚。本研究旨在评估 TIPS 联合序贯系统治疗在伴有 PVTT 相关 SPH 的晚期 HCC 患者中的临床价值。
采用 1:1 倾向评分匹配（PSM）后，回顾性分析了 42 例行 TIPS 置管加序贯系统治疗（A 组）和 42 例仅接受对症支持治疗（B 组）的患者。评估的结果是总生存期（OS）和 SPH 控制率。采用 Cox 比例风险回归分析比较两组的 OS。
A 组 TIPS 术成功率为 95.2%，无严重并发症发生。A 组和 B 组的再出血率分别为 5.0%和 73.7%（p<0.001），腹水控制率分别为 92.0%和 28.0%（p<0.001）。A 组的中位 OS 明显长于 B 组（9.6[95%CI：7.1，12.0] vs. 4.9[95%CI：3.9，5.8]个月，p<0.001）。多变量分析显示，TIPS 联合序贯系统治疗（风险比[HR]=5.799；95%CI：3.177，10.585；p<0.001）是 OS 的独立预后因素。此外，PVTT 程度（I+II）（p=0.008）、AFP≤400ng/ml（p=0.003）和 Child-Pugh 分级 A（p=0.046）是 OS 的显著预测因素。
TIPS 联合序贯系统治疗对伴有肿瘤栓子相关 SPH 的晚期 HCC 是安全可行的。
门静脉癌栓（PVTT）在晚期肝细胞癌（HCC）中很常见，可将代偿性门静脉高压转变为症状性门静脉高压（SPH）。
伴有 PVTT 相关 SPH 的 HCC 患者预后极差，指南中没有推荐有效的治疗方法。
因此，本研究探讨了利用经颈静脉肝内门体分流术（TIPS）治疗 SPH 结合晚期 HCC 患者序贯系统治疗的可行性和临床价值。这项研究可以填补当前研究数据的空白，为患者提供有临床意义的治疗选择。
