Comparative Analysis of Safety and Efficacy of Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma in Patients with and without Pre-Existing Transjugular Intrahepatic Portosystemic Shunts |
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| Affiliation: | 1. Division of Vascular and Interventional Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224;2. Division of Body MRI, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224;3. Division of Nuclear Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224;1. Department of Ultrasound, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China;2. Department of Interventional Therapy, Shenzhen People’s Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, China;3. Department of Interventional Therapy, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen 518035, China;4. Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen 518035, China;5. Biotherapy Center, Fuda Cancer Hospital of Jinan University, Guangzhou, China;6. Department of Oncology, Fuda Cancer Hospital of Jinan University, Guangzhou, China;7. Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China;1. US Anesthesia Partners of Texas, 12222 Merit Dr., Suite 700, Dallas, TX 75251;2. Department of Anesthesiology, Texas A&M College of Medicine, Bryan, Texas;3. US Anesthesia Partners of Florida, Advent Health Florida Hospital, Orlando, Florida;1. NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust And University Of Nottingham, Nottingham, United Kingdom;3. Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom;4. Centre for Liver Disease, Mater Misericordiae University Hospital, Dublin, Ireland;6. Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Morgagni-Pierantoni Hospital, Forlì, Italy;5. Hepatology & Gastroenterology Department, National Liver Institute, Menoufia University, Al Minufya, Egypt;1. Conventional and Interventional Radiology, Indian Institute of Liver and Digestive Sciences, Kolkata, West Bengal, India;2. Clinical Gastroenterology and Hepatology, Indian Institute of Liver and Digestive Sciences, Kolkata, West Bengal, India |
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| Abstract: | PurposeTo compare the safety and efficacy of transarterial chemoembolization for hepatocellular carcinoma (HCC) in patients with and without transjugular intrahepatic portosystemic shunts (TIPS).Materials and MethodsThis single-institution study included a retrospective review of 50 patients who underwent transarterial chemoembolization for HCC between January 2010 and April 2017. Twenty-five patients had preexisting TIPS, and 25 patients were selected to control for age, sex, and target tumor size. Baseline median Model for End-Stage Liver Disease (MELD; 13 TIPS, 9 control; P < .001) and albumin-bilirubin (ALBI; 3 TIPS, 2 control; P < .001) differed between groups. Safety was assessed on the basis of Common Terminology Criteria for Adverse Events (CTCAE) and change in MELD and ALBI grade assessed between 3 and 6 months. Efficacy was assessed by tumor response and time to progression (TTP).ResultsThere was 1 severe adverse event (CTCAE grade >2) in the TIPS group. There was no difference in the change in MELD or ALBI grade. Although there was no difference in tumor response (P = .19), more patients achieved a complete response in the control group (19/25, 76%) than in the TIPS group (13/25, 52%). There was no difference in TTP (P = .82). At 1 year, 2 patients in the control group and 3 patients in the TIPS group received a liver transplant. Seven patients died in the TIPS group.ConclusionsTransarterial chemoembolization is as safe and effective in patients with TIPS as in patients without TIPS, despite worse baseline liver function. Severe adverse events are rare and may be transient. |
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