TIPS improves outcomes in patients with HCC and symptomatic portal hypertension: a multi-institution experience

Cancer Imaging

Zhanwang Xiang¹  Mingsheng Huang¹  Huzheng Yan²  Zhenkang Qiu³  Fei Gao³  Kai Feng⁴ 

[1] Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, 510630, Guangzhou, China;Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, 510630, Guangzhou, China;Department of Minimally Invasive & Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, 510060, Guangzhou, China;Department of Minimally Invasive & Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, 510060, Guangzhou, China;Department of Radiology, The Third People’s Hospital of Shenzhen, Shenzhen, China;

关键词: Hepatocellular carcinoma;    Portal hypertension;    Child–Pugh stage;    TIPS;   

DOI  :  10.1186/s40644-022-00451-9

来源: Springer

【 摘 要 】

BackgroundHepatocellular carcinoma (HCC) with symptomatic portal hypertension (SPH) has poor prognosis. A transjugular intrahepatic portosystemic shunt (TIPS) relieves SPH, but its application in HCC remains unclear. We evaluated TIPS efficacy in patients with HCC and SPH.MethodsPre- and post-TIPS Child–pugh(C–P) scores and stages in 123 HCC patients with SPH from three centers were compared. The impact of postoperative C–P stage indicators on overall survival (OS) was explored.ResultsPost-TIPS responses to SPH included complete response (CR) (92 [74.8%]), partial response (PR) (23 [18.7%]), and nonresponse (NR) (8 [6.5%]). The control (proportion of CR and PR) for SPH was 93.5%. Median C–P scores pre-TIPS and at one month post-TIPS were 8 (IQR 6–9) and 7 (IQR 6–8), respectively (P < 0.001). Forty-one (33.3%) patients had C–P downstaging; 73 (59.3%) had lowered C–P scores; and 73 (59.3%) received intrahepatic local therapy post-TIPS. The median OS was 10.7 (1.1–55.2) months. Among the five indicators of C–P stage, lower post-TIPS ascites grading [(0/1)/(2/3); P = 0.014, HR = 0.31 (95% CI: 0.12–0.79)] and bilirubin [< 34/ ≥ 34 µmol/L; P = 0.022, HR = 0.47 (95% CI: 0.23–0.82)] and prothrombin time prolongation < 6 s [< 6/ ≥ 6 s; P = 0.001, HR = 0.17 (95% CI: 0.06–0.47)] were independent protective indicators of OS. These three indicators were included in the nomogram model to predict survival probabilities.ConclusionsTIPS is safe and effective for HCC with SPH. This procedure can relieve the symptoms, enable subsequent antitumor therapy, and bring survival benefits, possibly through improved liver function by reducing C–P stage.

【 授权许可】

CC BY