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Portal hypertension during TACE for liver cancer negatively affects outcomes

Patients with hepatocellular carcinoma and clinically evident portal hypertension had significantly lower rates of complete response, progression free survival and overall survival after treatment with transarterial chemoembolization compared with those without portal hypertension, according to recently published data.

“Our results suggest that patients with [clinically evident portal hypertension (CEPH)] have significantly increased risk of serious complications after TACE which may result in less TACE procedures, leading to lower [complete response] rate in patients with CEPH,” Nam Hee Kim, MD, from the Sungkyunkwan University School of Medicine, Korea, and colleagues wrote. “One possible explanation for this observation is that the liver is more likely to rely on arterial flow in patients with CEPH.”

To determine the impact of CEPH on the prognosis of HCC, the researchers analyzed the data of 388 patients with HCC and Child-Pugh A cirrhosis who underwent TACE between January 2000 and June 2014.

The cohort included 252 patients with CEPH. Those with CEPH had significantly higher levels of serum aspartate aminotransferase, total bilirubin and prothrombin time, and lower levels of serum albumin and platelet than those without CEPH. Additionally, patients with CEPH had significantly higher MELD scores (8.9 vs. 8; P < .001), higher proportions of portal vein thrombosis (31% vs. 14%; P < .001) and more advanced tumor stage (P = .001) than those without CEPH.

During follow-up, 64 patients had TACE suspended due to serious complications such as hepatic failure, sepsis, acute renal failure or pulmonary thromboembolism related to treatment. Patients with CEPH had a higher rate of serious complications (22.6% vs. 5.1%; P < .001) and higher risk for hepatic failure (15.5% vs. 2.2%; P < .001).

Patients with CEPH also had lower mean number of serially performed TACE procedures (2.2 vs. 2.8; P = .008); shorter median follow-up period (17 vs. 32 months; P < .001); lower rates of complete response at 1, 3 and 5 years (P < .001); lower rates of progression free survival at 1, 3 and 5 years (P < .001); and lower rates of overall survival at 1, 3 and 5 years (P < .001).

After multivariate analysis, the researchers found that CEPH correlated significantly with lower rates of complete response (HR = 0.16; 95% CI, 0.09-0.28), progression free survival (HR = 5.01; 95% CI, 3.08-8.12) and overall survival (HR = 2.95; 95% CI, 1.66-5.23).

“Our results suggest that CEPH should be regarded as a major negative prognostic factor after TACE,” the researchers concluded. “It should be taken into consideration when managing and counselling HCC patients who would undergo TACE procedures, even in Child-Pugh A cirrhotic patients.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.