Portal hypertension increases the risk of hepatic decompensation after 90Yttrium radioembolization in patients with hepatocellular carcinoma: a cohort study
Background: Transarterial radioembolization (TARE) is increasingly used in patients with hepatocellular carcinoma (HCC). This treatment can induce or impair portal hypertension, leading to hepatic decompensation. TARE also promotes changes in liver and spleen volumes that may modify therapeutic deci...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2023-10-01
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| Series: | Therapeutic Advances in Gastroenterology |
| Online Access: | https://doi.org/10.1177/17562848231206995 |
| _version_ | 1797644190405885952 |
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| author | Laura Carrión Ana Clemente-Sánchez Laura Márquez-Pérez Javier Orcajo-Rincón Amanda Rotger Enrique Ramón-Botella Manuel González-Leyte Miguel Echenagusía-Boyra Arturo Luis Colón Laura Reguera-Berenguer Rafael Bañares Diego Rincón Ana Matilla-Peña |
| author_facet | Laura Carrión Ana Clemente-Sánchez Laura Márquez-Pérez Javier Orcajo-Rincón Amanda Rotger Enrique Ramón-Botella Manuel González-Leyte Miguel Echenagusía-Boyra Arturo Luis Colón Laura Reguera-Berenguer Rafael Bañares Diego Rincón Ana Matilla-Peña |
| author_sort | Laura Carrión |
| collection | DOAJ |
| description | Background: Transarterial radioembolization (TARE) is increasingly used in patients with hepatocellular carcinoma (HCC). This treatment can induce or impair portal hypertension, leading to hepatic decompensation. TARE also promotes changes in liver and spleen volumes that may modify therapeutic decisions and outcomes after therapy. Objectives: We aimed to investigate the impact of TARE on the incidence of decompensation events and its predictive factors. Design: In all, 63 consecutive patients treated with TARE between February 2012 and December 2018 were retrospectively included. Methods: We assessed clinical (including Barcelona Clinic Liver Cancer stage, portal hypertension assessment, and liver decompensation), laboratory parameters, and liver and spleen volumes before and 6 and 12 weeks after treatment. A multivariate analysis was performed. Results: In total, 18 out of 63 (28.6%) patients had liver decompensation (ascites, variceal bleeding, jaundice, or encephalopathy) within the first 3 months after therapy, not associated with tumor progression. Clinically significant portal hypertension (CSPH) and bilobar treatment independently predicted the development of liver decompensation after TARE. A significant volume increase in the non-treated hemi-liver was observed only in patients with unilobar treatment (median volume increase of 20.2% in patients with right lobe TARE; p = 0.007), especially in those without CSPH. Spleen volume also increased after TARE (median volume increase of 16.1%; p = 0.0001) and was associated with worsening liver function scores and decreased platelet count. Conclusion: Bilobar TARE and CSPH may be associated with an increased risk of liver decompensation in patients with intermediate or advanced HCC. A careful assessment considering these variables before therapy may optimize candidate selection and improve treatment planning. |
| first_indexed | 2024-03-11T14:26:53Z |
| format | Article |
| id | doaj.art-1e433dea276e4f3d8e2c5c349b64613f |
| institution | Directory Open Access Journal |
| issn | 1756-2848 |
| language | English |
| last_indexed | 2024-03-11T14:26:53Z |
| publishDate | 2023-10-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Gastroenterology |
| spelling | doaj.art-1e433dea276e4f3d8e2c5c349b64613f2023-10-31T15:03:24ZengSAGE PublishingTherapeutic Advances in Gastroenterology1756-28482023-10-011610.1177/17562848231206995Portal hypertension increases the risk of hepatic decompensation after 90Yttrium radioembolization in patients with hepatocellular carcinoma: a cohort studyLaura CarriónAna Clemente-SánchezLaura Márquez-PérezJavier Orcajo-RincónAmanda RotgerEnrique Ramón-BotellaManuel González-LeyteMiguel Echenagusía-BoyraArturo Luis ColónLaura Reguera-BerenguerRafael BañaresDiego RincónAna Matilla-PeñaBackground: Transarterial radioembolization (TARE) is increasingly used in patients with hepatocellular carcinoma (HCC). This treatment can induce or impair portal hypertension, leading to hepatic decompensation. TARE also promotes changes in liver and spleen volumes that may modify therapeutic decisions and outcomes after therapy. Objectives: We aimed to investigate the impact of TARE on the incidence of decompensation events and its predictive factors. Design: In all, 63 consecutive patients treated with TARE between February 2012 and December 2018 were retrospectively included. Methods: We assessed clinical (including Barcelona Clinic Liver Cancer stage, portal hypertension assessment, and liver decompensation), laboratory parameters, and liver and spleen volumes before and 6 and 12 weeks after treatment. A multivariate analysis was performed. Results: In total, 18 out of 63 (28.6%) patients had liver decompensation (ascites, variceal bleeding, jaundice, or encephalopathy) within the first 3 months after therapy, not associated with tumor progression. Clinically significant portal hypertension (CSPH) and bilobar treatment independently predicted the development of liver decompensation after TARE. A significant volume increase in the non-treated hemi-liver was observed only in patients with unilobar treatment (median volume increase of 20.2% in patients with right lobe TARE; p = 0.007), especially in those without CSPH. Spleen volume also increased after TARE (median volume increase of 16.1%; p = 0.0001) and was associated with worsening liver function scores and decreased platelet count. Conclusion: Bilobar TARE and CSPH may be associated with an increased risk of liver decompensation in patients with intermediate or advanced HCC. A careful assessment considering these variables before therapy may optimize candidate selection and improve treatment planning.https://doi.org/10.1177/17562848231206995 |
| spellingShingle | Laura Carrión Ana Clemente-Sánchez Laura Márquez-Pérez Javier Orcajo-Rincón Amanda Rotger Enrique Ramón-Botella Manuel González-Leyte Miguel Echenagusía-Boyra Arturo Luis Colón Laura Reguera-Berenguer Rafael Bañares Diego Rincón Ana Matilla-Peña Portal hypertension increases the risk of hepatic decompensation after 90Yttrium radioembolization in patients with hepatocellular carcinoma: a cohort study Therapeutic Advances in Gastroenterology |
| title | Portal hypertension increases the risk of hepatic decompensation after 90Yttrium radioembolization in patients with hepatocellular carcinoma: a cohort study |
| title_full | Portal hypertension increases the risk of hepatic decompensation after 90Yttrium radioembolization in patients with hepatocellular carcinoma: a cohort study |
| title_fullStr | Portal hypertension increases the risk of hepatic decompensation after 90Yttrium radioembolization in patients with hepatocellular carcinoma: a cohort study |
| title_full_unstemmed | Portal hypertension increases the risk of hepatic decompensation after 90Yttrium radioembolization in patients with hepatocellular carcinoma: a cohort study |
| title_short | Portal hypertension increases the risk of hepatic decompensation after 90Yttrium radioembolization in patients with hepatocellular carcinoma: a cohort study |
| title_sort | portal hypertension increases the risk of hepatic decompensation after 90yttrium radioembolization in patients with hepatocellular carcinoma a cohort study |
| url | https://doi.org/10.1177/17562848231206995 |
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