Than Van Sy, Le Thanh Dung, Cao Manh Thau, Pham Minh Thong
Department of Radiology, Viet Duc University Hospital, Hanoi, Vietnam; Department of Radiology, University of Medicine and Pharmacy, Vietnam, National University, Hanoi, Vietnam; Department of Radiology, Hanoi Medical University, Hanoi, Vietnam.
Department of Radiology, Viet Duc University Hospital, Hanoi, Vietnam; Department of Radiology, University of Medicine and Pharmacy, Vietnam, National University, Hanoi, Vietnam; Department of Radiology, Hanoi Medical University, Hanoi, Vietnam.
J Vasc Interv Radiol. 2025 Sep 1. doi: 10.1016/j.jvir.2025.08.033.
To compare the safety and efficacy of simultaneous portal and hepatic vein embolization (PHVE) versus portal vein embolization (PVE) in enhancing future liver remnant (FLR) hypertrophy in patients with hepatocellular carcinoma (HCC).
This retrospective study included 97 patients with HCC who underwent transarterial chemoembolization (TACE) followed by PVE (n = 34) or PHVE (n = 63) for preoperative liver augmentation. Volumetric analysis using contrast-enhanced CT was performed at a median of 25 days (PHVE) and 31 days (PVE) post-embolization (P = .011). Primary outcome was FLR absolute hypertrophy (FLRabh). Multivariable linear regression including interaction terms, was used to identify predictors of FLRabh. Adverse events were graded using the Society of Interventional Radiology (SIR) classification.
PHVE achieved significantly greater FLRabh (51.3% vs. 27.0%, P < .001), degree of hypertrophy (13.4% vs. 10.1%, P = .01), and kinetic growth rate (4.2 vs. 2.9 %/week, P = .001) compared to PVE. Resection rates were higher in the PHVE group (95.2% vs. 76.5%, P = .008), with fewer tumor progressions during follow-up (3.2% vs. 14.7%, P = .049). Multivariable analysis confirmed PHVE as an independent predictor of greater FLR hypertrophy, particularly in patients with lower baseline FLR volumes. One adverse event occurred in each group (SIR Grades 1 and 3).
PHVE induces greater liver hypertrophy and is associated with lower tumor progression during the hypertrophy interval, supporting its role as an effective and safe option for surgical preparation in HCC with limited FLR.
比较同期门静脉和肝静脉栓塞术（PHVE）与门静脉栓塞术（PVE）在促进肝细胞癌（HCC）患者未来肝残余（FLR）肥大方面的安全性和有效性。
这项回顾性研究纳入了97例接受经动脉化疗栓塞术（TACE）后行PVE（n = 34）或PHVE（n = 63）以进行术前肝脏增大的HCC患者。在栓塞术后中位时间25天（PHVE）和31天（PVE）进行使用对比增强CT的容积分析（P = .011）。主要结局是FLR绝对肥大（FLRabh）。使用包括交互项的多变量线性回归来确定FLRabh的预测因素。不良事件使用介入放射学会（SIR）分类进行分级。
与PVE相比，PHVE实现了显著更大的FLRabh（51.3%对27.0%，P < .001）、肥大程度（13.4%对10.1%，P = .01）和动力学生长率（4.2对2.9%/周，P = .001）。PHVE组的切除率更高（95.2%对76.5%，P = .008），随访期间肿瘤进展更少（3.2%对14.7%，P = .049）。多变量分析证实PHVE是更大FLR肥大的独立预测因素，特别是在基线FLR体积较低的患者中。每组各发生1例不良事件（SIR 1级和3级）。
PHVE可诱导更大的肝脏肥大，并且在肥大间期与更低的肿瘤进展相关，支持其作为FLR有限的HCC手术准备的有效且安全选择的作用。
