Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure

Constantine Frangakis; Jae Ho Sohn; Ahmet Bas; Julius Chapiro; Ruediger E Schernthaner; MingDe Lin; James P Hamilton; Timothy M Pawlik; Kelvin Hong; Rafael Duran

doi:10.3389/fonc.2021.639235

Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure

Front Oncol. 2021 Nov 5:11:639235. doi: 10.3389/fonc.2021.639235. eCollection 2021.

Authors

Constantine Frangakis¹, Jae Ho Sohn², Ahmet Bas^{2

3}, Julius Chapiro^{2

4}, Ruediger E Schernthaner², MingDe Lin^{2

4}, James P Hamilton⁵, Timothy M Pawlik⁶, Kelvin Hong², Rafael Duran^{2

7}

Affiliations

¹ Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
² Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.
³ Department of Radiology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey.
⁴ Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States.
⁵ Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, United States.
⁶ Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, United States.
⁷ Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Abstract

Objectives: Investigate long-term effects of repeated transarterial chemoembolization (TACE) on portal venous pressure (PVP) using non-invasive surrogate markers of portal hypertension.

Methods: Retrospective, 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.

Results: No 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 1^stTACE 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%).

Conclusion: Repeated TACEs did seem to have an impact on PVP. However, the increase in PVP had marginal effects with low portal hypertension-related complications.

Keywords: HCC; TACE; hepatocellular carcinoma; longitudinal data analysis; portal hypertension; transarterial chemoembolization; variceal bleeding.