Prevalence and clinical significance of clinically evident portal hypertension in patients with hepatocellular carcinoma undergoing transarterial chemoembolization.
Prevalence and clinical significance of clinically evident portal hypertension in patients with hepatocellular carcinoma undergoing transarterial chemoembolization.
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DOI：
10.1002/ueg2.12188
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发表时间：
2022-03
影响因子：
6
通讯作者：
Kloeckner R
中科院分区：
文献类型：
--
作者：
Müller L;Hahn F;Mähringer-Kunz A;Stoehr F;Gairing SJ;Foerster F;Weinmann A;Galle PR;Mittler J;Pinto Dos Santos D;Pitton MB;Düber C;Fehrenbach U;Auer TA;Gebauer B;Kloeckner R
临床上明显的门静脉高压症（CEPH）以前被确定为肝细胞癌（HCC）患者的预后因素。然而，关于CEPH对接受经动脉化疗栓塞（TACE）的HCC患者的长期结局的预后影响，尤其是在西方人群中，知之甚少。本研究调查了接受TACE的西方HCC患者人群中CEPH的患病率和预后影响。这项回顾性研究包括2010年1月至2020年11月期间在我们的三级医疗中心接受初始TACE治疗的349例初治患者。CEPH被定义为腹水、食管/胃静脉曲张、脾肿大和血小板计数低的组合。我们评估了CEPH及其定义因素对HCC患者中位总生存期（OS）的影响。我们比较了CEPH与众所周知的预后因素的影响。在纳入的349例患者中，304例（87.1%）患者患有肝硬化。241例（69.1%）患者存在CEPH。CEPH患者的中位OS时间为10.6个月，无CEPH患者为17.1个月（对数秩p = 0.036）。无现有替代物的中位OS为17.1个月，而分别有1个以上现有CEPH替代物的患者的中位OS为10.8个月和9.4个月（对数秩p = 0.053）。在多变量分析中，CEPH不是OS的显著风险因素（p = 0.190）。在CEPH定义因素中，只有腹水在单变量分析中达到显著性。在我们的西方患者队列中，超过三分之二接受TACE的HCC患者存在CEPH。单因素分析显示，CEPH患者的生存率显著降低。然而，在多变量分析中没有达到显著性。因此，当认为TACE治疗在肿瘤学上合理时，不应仅因存在门脉高压替代物而将患者排除在TACE治疗之外。
Clinically evident portal hypertension (CEPH) was previously identified as a prognostic factor for patients with hepatocellular carcinoma (HCC). However, little is known about the prognostic influence of CEPH on the long‐term outcome of patients with HCC undergoing transarterial chemoembolization (TACE), particularly in Western populations. This study investigated the prevalence and prognostic influence of CEPH in a Western population of patients with HCC undergoing TACE. This retrospective study included 349 treatment‐naïve patients that received initial TACE treatment at our tertiary care center between January 2010 and November 2020. CEPH was defined as a combination of ascites, esophageal/gastric varices, splenomegaly and a low platelet count. We assessed the influence of CEPH and its defining factors on median overall survival (OS) in HCC patients. We compared the effects of CEPH to those of well‐known prognostic factors. Of the 349 patients included, 304 (87.1%) patients had liver cirrhosis. CEPH was present in 241 (69.1%) patients. The median OS times were 10.6 months for patients with CEPH and 17.1 months for patients without CEPH (log rank p = 0.036). Median OS without a present surrogate was 17.1 months, while patients with one respectively more than two present CEPH surrogates had a median OS of 10.8 and 9.4 months (log rank p = 0.053). In multivariate analysis, CEPH was no significant risk factor for OS (p = 0.190). Of the CEPH‐defining factors, only ascites reached significance in a univariate analysis. CEPH was present in more than two thirds of the patients with HCC undergoing TACE in our cohort of Western patients. Patients with CEPH had a significantly impaired survival in univariate analysis. However, no significance was reached in multivariate analysis. Thus, when TACE treatment is deemed oncologically reasonable, patients should not be excluded from TACE treatment due to the presence of surrogates of portal hypertension alone.
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DOI：
10.1148/ryai.2020190102
发表时间：
2020-07-01
期刊：
RADIOLOGY-ARTIFICIAL INTELLIGENCE
影响因子：
--
作者：
Humpire-Mamani, Gabriel E.;Bukala, Joris;Jacobs, Colin
通讯作者：
Jacobs, Colin
影响因子：
4.8
作者：
Nuffer, Zachary;Marini, Thomas;Bhatt, Shweta
通讯作者：
Bhatt, Shweta
影响因子：
81.5
作者：
Llovet, Josep M.;Zucman-Rossi, Jessica;Gores, Gregory
通讯作者：
Gores, Gregory
影响因子：
2.9
作者：
Lencioni, Riccardo;de Baere, Thierry;Burrel, Marta;Caridi, James G.;Lammer, Johannes;Malagari, Katerina;Martin, Robert C. G.;O'Grady, Elizabeth;Isabel Real, Maria;Vogl, Thomas J.;Watkinson, Anthony;Geschwind, Jean-Francois H.
通讯作者：
Geschwind, Jean-Francois H.
影响因子：
4.8
作者：
Linguraru, Marius George;Sandberg, Jesse K.;Jones, Elizabeth C.;Summers, Ronald M.
通讯作者：
Summers, Ronald M.