Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2019; 7(13): 1599-1610
Published online Jul 6, 2019. doi: 10.12998/wjcc.v7.i13.1599
Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma
Shi-Hua Luo, Jian-Guo Chu, He Huang, Ke-Chun Yao
Shi-Hua Luo, Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
Jian-Guo Chu, He Huang, Department of Radiology, Air Force Medical Center of PLA, Beijing 100142, China
Ke-Chun Yao, Department of Ultrasound, Air Force Medical Center of PLA, Beijing 100142, China
Author contributions: Chu JG designed the research; Luo SH and Huang H performed the research; Luo SH analyzed the data; Luo SH and Huang H wrote the paper; Yao KC revised the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Air Force Medical Center of PLA, Beijing, China.
Informed consent statement: This is a retrospective study, and informed written consent was thus waived.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian-Guo Chu, MD, Professor, Department of Radiology, Air Force Medical Center of PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China. cjgchina@126.com
Telephone: +86-10-66928523 Fax: +86-10-66928523
Received: January 29, 2019
Peer-review started: January 29, 2019
First decision: March 14, 2019
Revised: April 10, 2019
Accepted: May 1, 2019
Article in press: May 1, 2019
Published online: July 6, 2019
Processing time: 158 Days and 8.6 Hours
Abstract
BACKGROUND

There is a close relationship between cirrhosis and hepatocellular carcinoma (HCC). Transjugular intrahepatic portosystemic shunt (TIPS) has good clinical effect in treating the complication of portal hypertension. However, because of the risk of postoperative liver failure, severe complications, and low survival rate for HCC, TIPS is contraindicated in patients with portal hypertension and liver cancer. We studied a large cohort of patients with cirrhosis and HCC who underwent TIPS for recurrent variceal bleeding and/or ascites.

AIM

To assess the safety, efficacy, and survival rate in patients with HCC who underwent TIPS.

METHODS

Group A comprised 217 patients with HCC and portal hypertension who underwent the TIPS procedure between 1999 and 2014. After TIPS deployment, these patients received palliative treatment for HCC. Group B comprised a cohort of 136 HCC patients with portal hypertension who did not undergo TIPS placement. Group B received palliative treatment for HCC plus medical therapy for portal hypertension. The clinical outcomes and survival rate were assessed.

RESULTS

In Group A, the primary technical success rate was 97.69% for TIPS placement, and no severe procedure-related complications of TIPS placement were reported. The control of variceal bleeding (VB) within 1 mo did not differ significantly between the groups (P = 0.261). Absorption of refractory ascites within 1 mo, recurrence of VB, and recurrence of refractory ascites differed significantly between the groups (P = 0.017, 0.023, and 0.009, respectively). By comparison, the rate of hepatic encephalopathy in Group B was lower than that in Group A (P = 0.036). The 1-, 2-, 3-, 4-, and 5-year survival rates were significantly different between Groups A and B (χ2 = 12.227, P = 0.018; χ2 = 12.457, P = 0.014; χ2 = 26.490, P = 0.013; χ2 = 21.956, P = 0.009, and χ2 = 24.596, P = 0.006, respectively). The mean survival time was 43.7 mo in Group A and 31.8 mo in Group B. Median survival time was 50.0 mo in Group A and 33.0 mo in Group B. Mean and median survival differed significantly between the two groups (P = 0.000, χ2 = 35.605, log-rank test). The mortality rate from VB in Group A was low than that in Group B (P = 0.006), but the rates of hepatic tumor, hepatic failure, and multiorgan failure did not differ significantly between the two groups (P = 0.173, 0.246 and 0.257, respectively).

CONCLUSION

TIPS combined with palliative treatment is safe and effective for portal hypertension in patients with HCC.

Keywords: Hepatocellular carcinoma; Portal hypertension; Transjugular intrahepatic portosystemic shunt; Transarterial chemoembolization; Radiofrequency ablation

Core tip: We studied a large cohort of patients with cirrhosis and hepatocellular carcinoma (HCC) who underwent transjugular intrahepatic portosystemic shunt (TIPS) for recurrent variceal bleeding and/or ascites. They were compared with patients with cirrhosis and HCC who did not undergo TIPS placement. We conclude that TIPS combined with palliative treatment is safe and effective for portal hypertension in patients with HCC.