Simultaneous Portal and Hepatic Vein Embolization versus Portal Vein Embolization Only in Patients with Hepatocellular Carcinoma: A Retrospective Review of Safety and Effectiveness.
Van Sy Than, Thanh Dung Le, Manh Thau Cao, Minh Thong Pham
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引用次数: 0
Abstract
Purpose: To compare the safety and effectiveness of simultaneous portal and hepatic vein embolization (PHVE) versus portal vein embolization (PVE) in enhancing future liver remnant (FLR) hypertrophy in patients with hepatocellular carcinoma (HCC).
Materials and methods: This retrospective study included 97 patients with HCC who underwent transarterial chemoembolization followed by PVE (n = 34) or PHVE (n = 63) for preoperative liver augmentation. Volumetric analysis using contrast-enhanced computed tomography was performed at a median of 25 days (PHVE) and 31 days (PVE) after embolization (P = .011). Primary outcome was FLR absolute hypertrophy (FLRabh). Multivariable linear regression including interaction terms was used to identify predictors of FLRabh. Adverse events were graded using the Society of Interventional Radiology (SIR) classification.
Results: PHVE achieved significantly greater FLRabh (51.3% vs 27.0%, P < .001), degree of hypertrophy (13.4% vs 10.1%, P = .01), and kinetic growth rate (4.2 vs 2.9 %/wk, P = .001) compared with PVE. Resection rates were higher in the PHVE group (95.2% vs 76.5%, P = .008), with fewer tumor progressions during follow-up (3.2% vs 14.7%, P = .049). Multivariable analysis confirmed PHVE as an independent predictor of greater FLR hypertrophy, particularly in patients with lower baseline FLR volumes. One adverse event occurred in each group (SIR Grades 1 and 3).
Conclusions: PHVE induces greater liver hypertrophy and is associated with lower tumor progression during the hypertrophy interval, supporting its role as an effective and safe option for surgical preparation in HCC with limited FLR.
目的：比较门静脉和肝静脉同时栓塞（PHVE）与门静脉栓塞（PVE）在肝细胞癌（HCC）患者未来肝残余（FLR）肥厚增强中的安全性和有效性。材料和方法：本回顾性研究纳入了97例HCC患者，他们接受了经动脉化疗栓塞（TACE），然后进行PVE （n = 34）或PHVE （n = 63）术前肝增强。栓塞后中位时间为25天（PHVE）和31天（PVE），使用对比增强CT进行体积分析（P = 0.011）。主要终点为FLR绝对肥大（FLRabh）。采用多变量线性回归（包括相互作用项）来确定FLRabh的预测因子。不良事件按照介入放射学会（SIR）分级进行分级。结果：与PVE相比，PHVE的FLRabh （51.3% vs. 27.0%, P < 0.001）、肥大程度（13.4% vs. 10.1%, P = 0.01）和动态生长率（4.2 vs. 2.9% /周，P = 0.001）显著高于PVE。PHVE组的切除率更高（95.2% vs. 76.5%, P = 0.008），随访期间肿瘤进展较少（3.2% vs. 14.7%, P = 0.049）。多变量分析证实，PHVE是FLR较大肥厚的独立预测因子，特别是在基线FLR容量较低的患者中。每组均发生1例不良事件（SIR分级1级和3级）。结论：PHVE诱导更大的肝脏肥厚，并与肥厚期间较低的肿瘤进展相关，支持其作为FLR有限的HCC手术准备的有效和安全选择。
期刊介绍：
JVIR, published continuously since 1990, is an international, monthly peer-reviewed interventional radiology journal. As the official journal of the Society of Interventional Radiology, JVIR is the peer-reviewed journal of choice for interventional radiologists, radiologists, cardiologists, vascular surgeons, neurosurgeons, and other clinicians who seek current and reliable information on every aspect of vascular and interventional radiology. Each issue of JVIR covers critical and cutting-edge medical minimally invasive, clinical, basic research, radiological, pathological, and socioeconomic issues of importance to the field.
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