Polyvinyl alcohol chemoembolization for hepatocellular carcinoma with hepatopulmonary shunting: clinical efficacy and prognostic factors

doi:10.3877/cma.j.issn.2095-5782.2016.02.004

Abstract

Abstract:

Objective:

To evaluate the efficacy and prognosis of polyvinyl alcohol (PVA) chemoembolization in treating hepatocellular carcinoma (HCC) with hepatopulmonary shunting (HPS).

Methods:

A total of 42 patients' clinical data were retrospectively analyzed. According to the shunting pathway, the patients were divided into group A (portal-systemic shunting, n=9) and group B (arterio-hepatic vein shunting, n=33). Based on shunting speed, different amount of PVA was used to embolize the shunts. The overall survival (OS) and postoperative complications, etc. were analyzed in the follow-up study. Survival prognostic factors were assessed by univariate Kaplan-Meier analysis with Log-rank test and a multivariate Cox proportional hazard model.

Results:

The median OS of the 42 patients was 9.5 months, and the 6-month, 12-month survival rate were 74.9% and 39.4%, respectively. The median OS of the group A and group B were 10.5 months and 9.5 months, respectively, showing no significant difference between two groups (χ²=0.410, P=0.522). Cox multivariate survival analysis revealed that higher performance status (PS) score (HR=2.454, P=0.026), tumor burden >50% (HR=3.477, P=0.019) and main portal vein invasion (P=0.006) were independent risk factors. Multiple embolization (HR=0.329, P=0.008) was an independent protection factor.

Conclusion:

PVA chemoembolization is a safe and effective strategy for selected HCC patients with HPS . Multiple embolization can achieve better survival prognosis in HCC with HPS patients while for those with, tumor burden >50% and main portal vein invasion it showed poor survival prognosis.

Key words: Polyvinyl alcohol, Carcinoma, hepatocellular, Hepatopulmonary shunting, Treatment outcome, Prognosis

Qiusong Liu, Gongliang Zhang, Quelin Mei, Yanhao Li. Polyvinyl alcohol chemoembolization for hepatocellular carcinoma with hepatopulmonary shunting: clinical efficacy and prognostic factors[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2016, 04(02): 71-76.

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References 19

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参数		门静脉-腔静脉分流组（9例）	肝动脉-肝静脉分流组（33例）	χ²值	P值
分流速度类型		?	?	?	?
?	快速型	9	8	13.526	<0.001
?	中速型	0	11	?	?
?	慢速型	0	14	?	?
肿瘤边界		?	?	?	?
?	局限型	4	29	7.735	0.005
?	浸润型	5	4	?	?
肿瘤负荷		?	?	?	?
?	≤50%	7	18	1.546	0.214
?	>50%	2	15	?	?
BCLC分期^a		?	?	?	?
?	B	2	7	0.004	0.948
?	C	7	26	?	?
AFP (μg/L)		?	?	?	?
?	<400	3	15	0.414	0.520
?	≥400	6	18	?	?
门静脉癌栓		?	?	?	?
?	主干	5	5	1.423	0.233
?	一级分支	0	12	?	?
?	无	4	16	?	?
肝静脉癌栓		?	?	?	?
?	有	0	13	5.013	0.025
?	无	9	20	?	?

参数		门静脉-腔静脉分流组（9例）	肝动脉-肝静脉分流组（33例）	χ²值	P值
分流速度类型		?	?	?	?
?	快速型	9	8	13.526	<0.001
?	中速型	0	11	?	?
?	慢速型	0	14	?	?
肿瘤边界		?	?	?	?
?	局限型	4	29	7.735	0.005
?	浸润型	5	4	?	?
肿瘤负荷		?	?	?	?
?	≤50%	7	18	1.546	0.214
?	>50%	2	15	?	?
BCLC分期^a		?	?	?	?
?	B	2	7	0.004	0.948
?	C	7	26	?	?
AFP (μg/L)		?	?	?	?
?	<400	3	15	0.414	0.520
?	≥400	6	18	?	?
门静脉癌栓		?	?	?	?
?	主干	5	5	1.423	0.233
?	一级分支	0	12	?	?
?	无	4	16	?	?
肝静脉癌栓		?	?	?	?
?	有	0	13	5.013	0.025
?	无	9	20	?	?

因素	β	SE	Waldχ²	df	P	HR（95%CI）
肿瘤负荷	1.246	0.530	5.529	1	0.019	3.477（1.231～9.826）
PS评分^a	0.898	0.404	4.942	1	0.026	2.454（1.112～5.416）
多次栓塞治疗	-1.112	0.421	6.968	1	0.008	0.329（0.144～0.751）
门静脉癌栓	?	?	10.166	2	0.006	?
无:主干	-1.605	0.599	7.190	1	0.007	0.201（0.062～0.649）
一级分支:主干	-1.459	0.534	7.457	1	0.006	0.232（0.082～0.662）

因素	β	SE	Waldχ²	df	P	HR（95%CI）
肿瘤负荷	1.246	0.530	5.529	1	0.019	3.477（1.231～9.826）
PS评分^a	0.898	0.404	4.942	1	0.026	2.454（1.112～5.416）
多次栓塞治疗	-1.112	0.421	6.968	1	0.008	0.329（0.144～0.751）
门静脉癌栓	?	?	10.166	2	0.006	?
无:主干	-1.605	0.599	7.190	1	0.007	0.201（0.062～0.649）
一级分支:主干	-1.459	0.534	7.457	1	0.006	0.232（0.082～0.662）

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