Wang Tao, Du Ya-Nan, Sun Jiewei, Song Haiyang, Jiang Yutian, Liu Fuquan, Lv Xiaoning
Department of Interventional Radiology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China.
Department of Interventional Radiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
J Gastrointest Oncol. 2023 Feb 28;14(1):302-311. doi: 10.21037/jgo-23-76. Epub 2023 Feb 22.
Transarterial chemoembolization (TACE) is widely used for patients with unresectable hepatocellular carcinoma (HCC); however, previous studies have demonstrated that conventional TACE (cTACE) might affect hepatic hemodynamics, which both associate with liver cirrhosis and survival. Drug-eluting bead TACE (DEB-TACE) improves treatment efficacy and safety, but its effects on the hepatic hemodynamics of HCC patients with cirrhosis remain unknown.
This retrospective cohort study included unresectable HCC patients treated with DEB-TACE from April 2018 to September 2020, who had limited tumor burden and liver function. The hepatic hemodynamics was measured by hepatic venous pressure gradient (HVPG) using occlusion balloon catheter before and after treatment. Baseline characteristics of demography, laboratory (tumoral and liver-function) and hepatic hemodynamics were compared between patients with and without clinically significant portal hypertension (CSPH). Laboratory examination and imaging assessments were performed 4-6 weeks; overall survival (OS) was defined as the time from DEB-TACE initiation until death or last follow-up.
Twenty-four eligible consecutive HCC patients were included, with a median age of 58.0 years and 54.2% in Child-Pugh A class. During a median follow-up of 9.8 months, median OS for the whole cohort of patients reached 10.0 months. Kaplan-Meier survival curves and Cox regression analyses demonstrated that age >60 years, ascites, Eastern Cooperative Oncology Group (ECOG) score of 1, Child-Pugh B class, Model for End-Stage Liver Disease (MELD) score >10, and albumin (ALB) <35 g/L were prognostic factors for decreased OS (P<0.05). Importantly, hepatic hemodynamics were significantly improved in patients after treatment with DEB-TACE (7.5 5.3 mmHg of HVPG, P<0.001), especially for those with CSPH (13.6 10.2 mmHg of HVPG, P=0.014).
DEB-TACE can improve hepatic hemodynamics in HCC patients, especially those with CSPH. Combing these findings with its effects on tumor, DEB-TACE might be more suitable for HCC patients with cirrhosis.
经动脉化疗栓塞术（TACE）广泛应用于不可切除肝细胞癌（HCC）患者；然而，既往研究表明传统TACE（cTACE）可能会影响肝血流动力学，这与肝硬化和生存率均相关。载药微球TACE（DEB-TACE）提高了治疗效果和安全性，但其对肝硬化HCC患者肝血流动力学的影响尚不清楚。
这项回顾性队列研究纳入了2018年4月至2020年9月接受DEB-TACE治疗、肿瘤负荷和肝功能有限的不可切除HCC患者。使用闭塞球囊导管在治疗前后通过肝静脉压力梯度（HVPG）测量肝血流动力学。比较有和没有临床显著性门静脉高压（CSPH）患者的人口统计学、实验室（肿瘤和肝功能）和肝血流动力学的基线特征。在4-6周时进行实验室检查和影像学评估；总生存期（OS）定义为从开始DEB-TACE到死亡或最后一次随访的时间。
纳入24例符合条件的连续HCC患者，中位年龄58.0岁，Child-Pugh A级占54.2%。在中位随访9.8个月期间，整个队列患者的中位OS达到10.0个月。Kaplan-Meier生存曲线和Cox回归分析表明，年龄>60岁、腹水、东部肿瘤协作组（ECOG）评分为1、Child-Pugh B级、终末期肝病模型（MELD）评分>10和白蛋白（ALB）<35 g/L是OS降低的预后因素（P<0.05）。重要的是，DEB-TACE治疗后患者的肝血流动力学显著改善（HVPG为7.5±5.3 mmHg，P<0.001），尤其是CSPH患者（HVPG为13.6±10.2 mmHg，P=0.014）。
DEB-TACE可改善HCC患者的肝血流动力学，尤其是CSPH患者。将这些发现与其对肿瘤的影响相结合，DEB-TACE可能更适合肝硬化HCC患者。
