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TIPS improves outcomes in patients with HCC and symptomatic portal hypertension: a multi-institution experience
BACKGROUND: Hepatocellular 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. METHODS: Pre- and post-T...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8858571/ https://www.ncbi.nlm.nih.gov/pubmed/35183265 http://dx.doi.org/10.1186/s40644-022-00451-9 |
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author | Yan, Huzheng Qiu, Zhenkang Xiang, Zhanwang Feng, Kai Huang, Mingsheng Gao, Fei |
author_facet | Yan, Huzheng Qiu, Zhenkang Xiang, Zhanwang Feng, Kai Huang, Mingsheng Gao, Fei |
author_sort | Yan, Huzheng |
collection | PubMed |
description | BACKGROUND: Hepatocellular 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. METHODS: Pre- 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. RESULTS: Post-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. CONCLUSIONS: TIPS 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. |
format | Online Article Text |
id | pubmed-8858571 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-88585712022-02-23 TIPS improves outcomes in patients with HCC and symptomatic portal hypertension: a multi-institution experience Yan, Huzheng Qiu, Zhenkang Xiang, Zhanwang Feng, Kai Huang, Mingsheng Gao, Fei Cancer Imaging Research Article BACKGROUND: Hepatocellular 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. METHODS: Pre- 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. RESULTS: Post-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. CONCLUSIONS: TIPS 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. BioMed Central 2022-02-19 /pmc/articles/PMC8858571/ /pubmed/35183265 http://dx.doi.org/10.1186/s40644-022-00451-9 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Yan, Huzheng Qiu, Zhenkang Xiang, Zhanwang Feng, Kai Huang, Mingsheng Gao, Fei TIPS improves outcomes in patients with HCC and symptomatic portal hypertension: a multi-institution experience |
title | TIPS improves outcomes in patients with HCC and symptomatic portal hypertension: a multi-institution experience |
title_full | TIPS improves outcomes in patients with HCC and symptomatic portal hypertension: a multi-institution experience |
title_fullStr | TIPS improves outcomes in patients with HCC and symptomatic portal hypertension: a multi-institution experience |
title_full_unstemmed | TIPS improves outcomes in patients with HCC and symptomatic portal hypertension: a multi-institution experience |
title_short | TIPS improves outcomes in patients with HCC and symptomatic portal hypertension: a multi-institution experience |
title_sort | tips improves outcomes in patients with hcc and symptomatic portal hypertension: a multi-institution experience |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8858571/ https://www.ncbi.nlm.nih.gov/pubmed/35183265 http://dx.doi.org/10.1186/s40644-022-00451-9 |
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