Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure
ObjectivesInvestigate long-term effects of repeated transarterial chemoembolization (TACE) on portal venous pressure (PVP) using non-invasive surrogate markers of portal hypertension.MethodsRetrospective, Institutional Review Board-approved study. 99 patients [hepatocellular carcinoma (HCC) group (n...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:2480e67ff1f1419985efa04cc88ef54c2021-11-05T11:23:26ZLongitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure2234-943X10.3389/fonc.2021.639235https://doaj.org/article/2480e67ff1f1419985efa04cc88ef54c2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.639235/fullhttps://doaj.org/toc/2234-943XObjectivesInvestigate long-term effects of repeated transarterial chemoembolization (TACE) on portal venous pressure (PVP) using non-invasive surrogate markers of portal hypertension.MethodsRetrospective, Institutional Review Board-approved study. 99 patients [hepatocellular carcinoma (HCC) group (n=57); liver metastasis group (n=42)] who underwent 279TACEs and had longitudinal pre-/post-therapy contrast-enhanced-MRI (n=388) and complete blood work were included. Outcomes of interest were platelet count (PC), spleen volume, ascites and portosystemic collaterals. Variables included TACE type/number, tumor type, microcatheter location, Child-Pugh, baseline tumor burden (tumor number/total/largest size), vessel invasion, alpha-fetoprotein, Eastern Cooperative Oncology Group (ECOG) performance status, and Model for End-Stage Liver Disease (MELD) score. Generalized Estimating Equations assessed the associations between TACE and outcomes. Power analysis determined the sample size was sufficient.ResultsNo significant change in PC over time was observed in either groups, regardless of liver function (P>0.05). Baseline spleen volume was 226 cm3 for metastatic group, and was larger by 204 cm3 for HCC group (P<0.001). Spleen volume increased by 20 cm3 (95%CI: 8-32; P=0.001) for both groups after 1stTACE and by 16cm3/TACE (P=0.099) over the full follow-up (up to 9TACEs). Spleen volume also tended to increase by 23cm3 (95%CI: -1–48; P=0.064) with higher tumor burden. Odds of developing moderate/severe ascites for metastatic patients was decreased by 0.5 (95%CI: 0.3–0.9; P=0.014), regardless of the Child-Pugh, and increased by 1.5 (95%CI: 1.2–1.9; P<0.001) among HCC patients with unstable Child-Pugh, whereas no change was noted with stable Child-Pugh. HCC patients with unstable Child-Pugh demonstrated a significant increase in portosystemic collaterals number over time (P=0.008). PVP-related complications such as variceal bleeding post-TACE were low (0.4%).ConclusionRepeated TACEs did seem to have an impact on PVP. However, the increase in PVP had marginal effects with low portal hypertension-related complications.Constantine FrangakisJae Ho SohnAhmet BasAhmet BasJulius ChapiroJulius ChapiroRuediger E. SchernthanerMingDe LinMingDe LinJames P. HamiltonTimothy M. PawlikKelvin HongRafael DuranRafael DuranFrontiers Media S.A.articleportal hypertensionlongitudinal data analysistransarterial chemoembolizationTACEhepatocellular carcinomaHCCNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021) |
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| topic |
portal hypertension longitudinal data analysis transarterial chemoembolization TACE hepatocellular carcinoma HCC Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 |
| spellingShingle |
portal hypertension longitudinal data analysis transarterial chemoembolization TACE hepatocellular carcinoma HCC Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Constantine Frangakis Jae Ho Sohn Ahmet Bas Ahmet Bas Julius Chapiro Julius Chapiro Ruediger E. Schernthaner MingDe Lin MingDe Lin James P. Hamilton Timothy M. Pawlik Kelvin Hong Rafael Duran Rafael Duran Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure |
| description |
ObjectivesInvestigate long-term effects of repeated transarterial chemoembolization (TACE) on portal venous pressure (PVP) using non-invasive surrogate markers of portal hypertension.MethodsRetrospective, Institutional Review Board-approved study. 99 patients [hepatocellular carcinoma (HCC) group (n=57); liver metastasis group (n=42)] who underwent 279TACEs and had longitudinal pre-/post-therapy contrast-enhanced-MRI (n=388) and complete blood work were included. Outcomes of interest were platelet count (PC), spleen volume, ascites and portosystemic collaterals. Variables included TACE type/number, tumor type, microcatheter location, Child-Pugh, baseline tumor burden (tumor number/total/largest size), vessel invasion, alpha-fetoprotein, Eastern Cooperative Oncology Group (ECOG) performance status, and Model for End-Stage Liver Disease (MELD) score. Generalized Estimating Equations assessed the associations between TACE and outcomes. Power analysis determined the sample size was sufficient.ResultsNo significant change in PC over time was observed in either groups, regardless of liver function (P>0.05). Baseline spleen volume was 226 cm3 for metastatic group, and was larger by 204 cm3 for HCC group (P<0.001). Spleen volume increased by 20 cm3 (95%CI: 8-32; P=0.001) for both groups after 1stTACE and by 16cm3/TACE (P=0.099) over the full follow-up (up to 9TACEs). Spleen volume also tended to increase by 23cm3 (95%CI: -1–48; P=0.064) with higher tumor burden. Odds of developing moderate/severe ascites for metastatic patients was decreased by 0.5 (95%CI: 0.3–0.9; P=0.014), regardless of the Child-Pugh, and increased by 1.5 (95%CI: 1.2–1.9; P<0.001) among HCC patients with unstable Child-Pugh, whereas no change was noted with stable Child-Pugh. HCC patients with unstable Child-Pugh demonstrated a significant increase in portosystemic collaterals number over time (P=0.008). PVP-related complications such as variceal bleeding post-TACE were low (0.4%).ConclusionRepeated TACEs did seem to have an impact on PVP. However, the increase in PVP had marginal effects with low portal hypertension-related complications. |
| format |
article |
| author |
Constantine Frangakis Jae Ho Sohn Ahmet Bas Ahmet Bas Julius Chapiro Julius Chapiro Ruediger E. Schernthaner MingDe Lin MingDe Lin James P. Hamilton Timothy M. Pawlik Kelvin Hong Rafael Duran Rafael Duran |
| author_facet |
Constantine Frangakis Jae Ho Sohn Ahmet Bas Ahmet Bas Julius Chapiro Julius Chapiro Ruediger E. Schernthaner MingDe Lin MingDe Lin James P. Hamilton Timothy M. Pawlik Kelvin Hong Rafael Duran Rafael Duran |
| author_sort |
Constantine Frangakis |
| title |
Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure |
| title_short |
Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure |
| title_full |
Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure |
| title_fullStr |
Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure |
| title_full_unstemmed |
Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure |
| title_sort |
longitudinal analysis of the effect of repeated transarterial chemoembolization for liver cancer on portal venous pressure |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/2480e67ff1f1419985efa04cc88ef54c |
| work_keys_str_mv |
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