Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma

Table 1 Baseline characteristics in the two groups

Characteristic	Group A	Group B	P value
Gender, M/F	115/97	76/60	0.526
Age, mean ± SD, yr	46.32 ± 12.43	44.79 ± 13.62	0.539
Child–Pugh A/B/C	54/129/34	33/83/20	0.462
MELD score, mean ± SD	10.21 ± 5.25	11.37 ± 4.17	0.645
BCLC staging A/B/C/D	18/107/53/34	12/67/34/23	0.518
Viral hepatitis	125	88	0.803
Chronic ethanol consumption	66	31	0.461
Cryptogenic hepatitis	26	17	0.724
VB	170	114	0.163
RA	47	22	0.217
Both VB and RA	69	35	0.167
Laboratory tests
AFP, ng/mL	468.53 ± 34.27	513.64 ± 25.19	0.625
Alanine transaminase, U/L	58.24 ± 14.32	61.14 ± 12.06	0.723
Aspartate transaminase, U/L	63.42 ± 16.21	59.34 ± 14.16	0.439
Alkaline phosphatase, U/L	196.23 ± 64.38	183.34 ± 84.64	0.376
Total bilirubin, μmol/L	29.13 ± 4.35	31.06 ± 5.24	0.634
Albumin, g/L	28.41 ± 4.37	27.13 ± 5.43	0.361
Prothrombin time, s	17.21 ± 5.34	19.42 ± 6.43	0.428
Platelet count, × 109/L	73.18 ± 21.43	67.46 ± 18.54	0.621
Clinical presentation
Abdominal distention	127	78	0.153
Abdominal pain	146	86	0.167
Weakness	153	89	0.184
Poor appetite	167	92	0.076
Jaundice	23	11	0.129
Splenomegaly	117	73	0.289
Lower limbs edema	25	14	0.141

No difference (P > 0.05) could be seen in terms of age, sex, Child–Pugh score, and MELD score, laboratory tests and clinical presentations. AFP: α-Fetoprotein; MELD score: Model for end-stage liver disease score, VB: Variceal bleeding; RA: Refractory ascites; BCLC staging: Barcelona Clinic Liver Cancer staging; SD: Standard deviation.

Table 2 Hepatocellular carcinoma therapy in the two groups

Method	Group A n = 212	Group B n = 136	P value
TACE, No. of times	483	269	0.043
RFA, No. of times	364	175	0.037

Minor differences (P < 0.05) could be seen in number of times of therapy for TACE and RFA between the two groups. RFA: Radiofrequency ablation; TACE: Transarterial chemoembolization.

Table 3 Liver function recovery in Group A

Timing of TIPS	TACE first n = 133	TIPS first n = 79	P value
2 wk	81	17	0.008
4 wk	46	49	0.014
Hepatic failure	6	13	0.012

Liver function recovery in cases of TIPS placement followed by TACE was more satisfactory than in the cases of TIPS placement before TACE, and there was a significant difference (P < 0.05). TIPS: Transjugular intrahepatic portosystemic shunt; TACE: Transarterial chemoembolization.

Table 4 Outcomes of symptoms in the two groups

Symptom	Group A	Group B	P value
Control of VB within 1 mo	153 (153/168, 91.07%)	98 (98/114, 85.96%)	0.261
Absorption of RA within 1 mo	39 (39/44, 88.63%)	9 (9/22, 40.90%)	0.017
Recurrence of VB	28 (28/168, 16.67%)	56 (56/114, 49.12%)	0.023
Recurrence of RA	13 (13/44, 29.54%)	19 (19/22, 86.36%)	0.009
HE	37 (37/212, 17.45%)	12 (12/136, 8.82%)	0.036

Control of VB within 1 mo did not differ significantly between the groups (P = 0.261). Absorption of RA within 1 mo, recurrence of VB, and recurrence of RA were significantly different between the groups (P = 0.017, 0.023 and 0.009, respectively). By comparison, the rate of HE in Group B was significantly lower than in Group A (P = 0.036). VB: Variceal bleeding; RA: Refractory ascites; HE: Hepatic encephalopathy.

Table 5 1-, 2-, 3-, 4-, and 5-year survival rates in the two groups

Time	Group	Survival		Survival rate, %	χ2	P value
		Yes	No
1 yr	A	188	24	88.67	12.227	0.018
	B	101	35	74.26
2 yr	A	169	43	79.71	12.457	0.014
	B	85	51	62.50
3 yr	A	145	67	68.39	26.490	0.013
	B	55	81	40.44
4 yr	A	115	97	54.24	21.956	0.009
	B	39	97	28.67
5 yr	A	88	124	41.51	24.596	0.006
	B	22	114	16.18

The 1-, 2-, 3-, 4-, and 5-year survival rates differed significantly between Groups A and B.

Table 6 Results of mRECIST in the two groups of liver tumor

HCC treatment response	Group A n = 212	Group B n = 136	P value
CR	5	3
PR	37	28
SD	62	41
PD	108	64
Disease control rate	49.05%	52.94%	0.249

The disease control rate (CR+PR+SD) was no difference between the two groups (P = 0.249). mRECIST: Modified Response Evaluation Criteria in Solid Tumors; CR: Complete response; PR: Partial response; SD: Stable disease; PD: Progressive disease.

Table 7 Causes of death in the two groups

Classification of death	Group A	Group B	P value
VB	7 (7/212, 3.30%)	42 (42/136, 30.88%)	0.006
Hepatic tumor	56 (56/212, 26.41%)	29 (29/136, 21.32%)	0.173
Hepatic failure	25 (25/212, 11.79%)	23 (23/136, 16.91%)	0.246
Multiorgan failure	24 (24/212, 11.32%)	17 (17/136, 12.50%)	0.257
Others	12	3	/

The mortality rate for VB in Group A was lower than 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, 0.257, respectively). VB: Variceal bleeding.