Transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension

Table 1 Baseline characteristics of patients

Characteristics	n (%)/mean ± SD/M (P25-P75)
Gender (male/female)	70/13 (84.3/15.7)
Age (yr)	56.46 ± 8.97
BMI	22.83 ± 2.99
Etiology of cirrhosis (HBV/HCV/alcoholic/other)	66/8/4/5 (79.5/9.6/4.8/6.0)
Cirrhosis-related decompensated events (EGVB/Refractory ascites or hydrothorax/Both)	62/14/7 (74.7/16.9/8.4)
EGV degree (mild/moderate/severe)	7/36/40 (8.4/43.4/48.2)
Ascites degree (no/mild/moderate-severe)	8/24/51 (9.6/28.9/61.4)
Preoperative HVPG (mmHg)	19.96 ± 9.01
Child–Pugh grade (A/B/C)	23/52/8 (27.7/62.7/9.6)
Intrahepatic HCC morphology (unifocal/multifocal)	47/36 (56.6/43.4)
Sum of longest viable tumor diameters (cm)	6.62 ± 2.77
≤ 5/5-8/> 8	23/44/16 (27.7/53.0/19.3)
BCLC stage (C/D)	75/8 (90.4/9.6)
cTNM stage (IIIB/IVA/IVB)	55/19/9 (66.3/22.9/10.8)
PLT (109/L)	108.24 ± 86.09
PT (s)	14.89 ± 3.89
ALT (U/L)	31.40 ± 29.29
AST (U/L)	49.63 ± 45.00
TBil (μmol/L)	31.74 ± 17.68
Albumin (g/L)	35.08 ± 4.85
AFP (ng/mL)1	769.49 (16.69-2345.11)
Log10(AFP)	2.40 ± 1.26
Combined TACE/RFA/targeted therapy	83/52/41 (100/62.7/49.4)

¹Skewness distribution. The upper limit of AFP detection is 20000 ng/mL. BMI: Body mass index; HBV: Hepatitis B virus; HCV: Hepatitis C virus; EGVB: Esophagogastric variceal bleeding; EGV: Esophagogastric varices; HVPG: Hepatic venous pressure gradient; HCC: Hepatocellular carcinoma; PLT: Platelet; PT: Prothrombin time; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TBil: Total bilirubin; AFP: Alpha-fetoprotein; TACE: Transarterial chemoembolization; RFA: Radiofrequency ablation.

Table 2 Summary of long-term efficacy and safety

Items	6 mo	12 mo	24 mo
Cumulative survival rate (%)	83.1	49.7	21.8
Cumulative rate of shunt stenosis (%)	13.3	28.9	38.6
Cumulative recurrence rate of CPH (%)	9.6	22.9	33.7

CPH: Cirrhotic portal hypertension.

Table 3 Summary of portal vein tumor thrombosis response in short-term efficacy

PVTT response	CR	PR	SD	PD	Response (ORR)
Number (%)	15 (18.1)	41 (49.4)	17 (20.5)	6 (7.2)	56 (67.5)

PVTT: Portal vein tumor thrombosis; CR: Complete response; PR: Partial response; SD: Stable disease; PD: Progressive disease; ORR: Objective response rate.

Table 4 Summary of survival comparison of different stratification factors

Stratification indicator	Log-rank χ2	P value
Gender	0.448	0.503
Age group	5.311	0.021
EGV degree	0.448	0.600
Ascites degree	1.308	0.520
Child-Pugh grade	15.810	< 0.001
Intrahepatic HCC morphology	0.174	0.677
Group of tumor diameters	1.685	0.431
BCLC stage	10.883	< 0.001
cTNM stage	51.774	< 0.001
Combined with RFA	0.275	0.600
Combined with targeted therapy	0.001	0.978
PVTT response	22.617	< 0.001
Post-TIPS HE	0.255	0.613
Shunt stenosis	0.027	0.868
Recurrence of CPH	0.235	0.628

EGV: Esophagogastric varices; HCC: Hepatocellular carcinoma; BCLC: Barcelona Clinic Liver Cancer; RFA: Radiofrequency ablation; PVTT: Portal vein tumor thrombosis; TIPS: Transjugular intrahepatic portosystemic shunt; HE: Hepatic encephalopathy; CPH: Cirrhotic portal hypertension.

Table 5 Correlative factors for survival in univariate and multivariate analyses

Variable	Univariate analysis			Multivariate analysis
	HR	95%CI	P value	HR	95%CI	P value
Gender (female/male)	1.237	0.650-2.355	0.518
Age (years)	1.039	1.011-1.068	0.006
BMI	0.781	0.701-0.871	< 0.001	0.861	0.768-0.965	0.010
EGV degree (mild/moderate/severe)	1.130	0.796-1.605	0.493
Ascites degree (no/mild/moderate-severe)	1.055	0.760-1.464	0.748
Preoperative HVPG (mmHg)	1.006	0.979-1.034	0.668
Child-Pugh grade			< 0.001
A/B	1.856	1.068-3.225	0.028	2.243	1.270-3.961	0.005
A/C	4.999	2.099-11.907	< 0.001	7.308	2.898-18.425	< 0.001
Intrahepatic HCC morphology (unifocal/multifocal)	0.909	0.570-1.447	0.687
Sum of longest viable tumor diameters (cm)	1.070	0.988-1.158	0.097
BCLC stage (C/D)	3.216	1.509-6.851	0.002
cTNM stage (IIIB/IVA/IVB)	3.269	2.228-4.795	< 0.001	2.745	1.726-4.366	< 0.001
PLT (109/L)	1.000	0.997-1.003	0.917
PT (s)	1.006	0.959-1.056	0.802
ALT (U/L)	1.004	0.994-1.013	0.465
AST (U/L)	1.003	0.998-1.008	0.173
TBil (μmol/L)	1.022	1.008-1.035	0.001
Albumin (g/L)	0.929	0.886-0.974	0.002
Log10(AFP) (ng/mL)	1.341	1.097-1.639	0.004
Combined RFA (no/yes)	0.885	0.552-1.419	0.612
Combined targeted therapy (no/yes)	0.994	0.627-1.574	0.978
Reduction of PVP (mmHg)	1.025	0.983-1.069	0.247
PVTT response (nonresponse/response)	0.302	0.176-0.516	< 0.001	0.472	0.259-0.859	0.014
Post-TIPS HE (no/yes)	0.864	0.482-1.551	0.625
Shunt stenosis (no/yes)	1.039	0.650-1.662	0.873
Recurrence of CPH (no/yes)	1.122	0.694-1.814	0.639

BMI: Body mass index; EGV: Esophagogastric varices; HVPG: Hepatic venous pressure gradient; HCC: Hepatocellular carcinoma; PLT: Platelet; PT: Prothrombin time; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TBil: Total bilirubin; AFP: Alpha-fetoprotein; RFA: Radiofrequency ablation; PVP: Portal vein pressure; PVTT: Portal vein tumor thrombosis; TIPS: Transjugular intrahepatic portosystemic shunt; HE: Hepatic encephalopathy; CPH: Cirrhotic portal hypertension.