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

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

JOURNAL=Frontiers in Oncology

VOLUME=11

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.639235

DOI=10.3389/fonc.2021.639235

ISSN=2234-943X

ABSTRACT=<sec><title>Objectives</title><p>Investigate long-term effects of repeated transarterial chemoembolization (TACE) on portal venous pressure (PVP) using non-invasive surrogate markers of portal hypertension.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>No significant change in PC over time was observed in either groups, regardless of liver function (<italic>P</italic>&gt;0.05). Baseline spleen volume was 226 cm<sup>3</sup> for metastatic group, and was larger by 204 cm<sup>3</sup> for HCC group (<italic>P</italic>&lt;0.001). Spleen volume increased by 20 cm<sup>3</sup> (95%CI: 8-32; <italic>P</italic>=0.001) for both groups after 1<sup>st</sup>TACE and by 16cm<sup>3</sup>/TACE (<italic>P</italic>=0.099) over the full follow-up (up to 9TACEs). Spleen volume also tended to increase by 23cm<sup>3</sup> (95%CI: -1–48; <italic>P</italic>=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; <italic>P</italic>=0.014), regardless of the Child-Pugh, and increased by 1.5 (95%CI: 1.2–1.9; <italic>P</italic>&lt;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 (<italic>P</italic>=0.008). PVP-related complications such as variceal bleeding post-TACE were low (0.4%).</p></sec><sec><title>Conclusion</title><p>Repeated TACEs did seem to have an impact on PVP. However, the increase in PVP had marginal effects with low portal hypertension-related complications.</p></sec>