Non selective beta-blockers prevent PHT-related complications occurrence in HCC patients with esophageal varices treated by TACE

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology Pub Date : 2024-11-13 DOI:10.1016/j.clinre.2024.102496

Manon Allaire , Hélène Garcia , Louis Meyblum , Sarah Mouri , Eléonore Spitzer , Claire Goumard , Olivier Lucidarme , Marika Rudler , Olivier Scatton , Charles Roux , Mathilde Wagner , Dominique Thabut

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引用次数: 0

Abstract

Introduction

We aimed to investigate the parameters associated with portal hypertension (PHT)-related complications occurrence in hepatocellular carcinoma (HCC) patients treated by transarterial chemoembolization (TACE), with a focus on non-selective beta blockers (NSBBs) due to their impact on preventing liver decompensation.

Methods

We included all patients with HCC for whom endoscopy was available the day of first TACE (2013-2023). The occurrence of PHT-related complications was defined as the appearance of ascites, acute variceal bleeding or hepatic encephalopathy (HE) post-TACE treatment and prior to HCC progression. Inappropriate treatment by NSBBs was defined by the lack of NSBBs in patients with small/large esophageal varices (EV).

Results

109 patients were included (age 67 years, 80 % male) and 65 % had EV. No NSBBs prescription despite indication was observed in 32 % and 81 % of patients with large and small size EV, respectively. Median progression free survival and overall survival were 10 and 23 months, respectively, and 27 % of patients underwent LT.

During the follow-up, 20 patients presented PHT-related complications with an incidence of 18 % at 12months (90 % with EV,67 % not treated by NSBB while indicated). Among them, 11 presented HCC progression, 2 were transplanted and 78 % presented liver decompensation that impaired the access to further HCC treatment. In multivariate analysis, a history of HE (HR=55.39,95 %CI[7.42-413.26]) and inappropriate NSBBs treatment (HR=4.16,95 %CI[1.45-11.81]) were associated with PHT-related complications occurrence.

Conclusion

The lack of NSBBs was independently associated with PHT-related complications after TACE, precluding access to further HCC treatment in 78 % of patients with HCC progression. Appropriate screening and PHT prophylaxis are needed in HCC patients who undergo TACE to improve their outcomes.

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非选择性β-受体阻滞剂可预防接受 TACE 治疗的食管静脉曲张 HCC 患者出现 PHT 相关并发症。

我们旨在研究经动脉化疗栓塞术（TACE）治疗的肝细胞癌（HCC）患者发生门静脉高压（PHT）相关并发症的相关参数，重点是非选择性β受体阻滞剂（NSBB），因为它们对防止肝脏失代偿有影响。我们纳入了所有在首次TACE当天可进行内镜检查的HCC患者（2013-2023年）。PHT相关并发症的发生定义为TACE治疗后、HCC进展前出现腹水、急性静脉曲张出血或肝性脑病（HE）。小/大食管静脉曲张（EV）患者未使用NSBBs治疗的定义为NSBBs治疗不当。共纳入109名患者（67岁，80%为男性），其中65%患有EV。分别有32%和81%的大型和小型食管静脉曲张患者尽管有适应症，但没有处方NSBBs。中位无进展生存期和总生存期分别为10个月和23个月，27%的患者接受了LT治疗。在随访期间，有20名患者在12个月时出现了PHT相关并发症，发生率为18%（90%为EV，67%在有指征时未接受NSBB治疗）。其中，11 例出现 HCC 进展，2 例进行了移植，78% 出现肝功能失代偿，影响了进一步的 HCC 治疗。在多变量分析中，HE病史（HR=55.39，95%CI[7.42-413.26]）和不适当的NSBBs治疗（HR=4.16，95%CI[1.45-11.81]）与PHT相关并发症的发生有关。缺乏NSBBs与TACE后PHT相关并发症的发生密切相关，78%的HCC进展患者因此无法接受进一步的HCC治疗。需要对接受TACE的HCC患者进行适当的筛查和PHT预防，以改善他们的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinics and research in hepatology and gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

4.30

自引率

3.70%

发文量

198

审稿时长

42 days

期刊介绍： Clinics and Research in Hepatology and Gastroenterology publishes high-quality original research papers in the field of hepatology and gastroenterology. The editors put the accent on rapid communication of new research and clinical developments and so called "hot topic" issues. Following a clear Editorial line, besides original articles and case reports, each issue features editorials, commentaries and reviews. The journal encourages research and discussion between all those involved in the specialty on an international level. All articles are peer reviewed by international experts, the articles in press are online and indexed in the international databases (Current Contents, Pubmed, Scopus, Science Direct). Clinics and Research in Hepatology and Gastroenterology is a subscription journal (with optional open access), which allows you to publish your research without any cost to you (unless you proactively chose the open access option). Your article will be available to all researchers around the globe whose institution has a subscription to the journal.