中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 40 Issue 10
Oct.  2024
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(10): 2027-2033

Efficacy of transjugular intrahepatic portosystemic shunt in treatment of hepatocellular carcinoma comorbid with esophagogastric variceal bleeding

DOI: 10.12449/JCH241016
  • 1.

    Hepatology Unit，Nanfang Hospital，Southern Medical University，Guangzhou 510515，China

  • 2.

    Department of Hepatology，Zengcheng Branch of Nanfang Hospital，Southern Medical University，Guangzhou 511300，China

  • 3.

    Hepatology Institute of Guangdong Province，Guangzhou 510515，China

Research funding:

National Natural Science Foundation of China (82300698);

National Natural Science Foundation of China (82370614)

More Information
  • Corresponding author: CHEN Jinjun， chjj@smu.edu.cn （ORCID： 0000-0003-4275-9149）; LUO Xiaoqin， lingdu618@126.com （ORCID： 0009-0002-3907-1087）
  • Received Date: 2024-01-12
  • Accepted Date: 2024-03-04
  • Published Date: 2024-10-25
    Abstract
  •   Objective  To investigate the efficacy of transjugular intrahepatic portosystemic shunt （TIPS） in preventing rebleeding in patients with hepatocellular carcinoma （HCC） comorbid with esophagogastric variceal bleeding and the influencing factors for prognosis.  Methods  A retrospective analysis was performed for the clinical data of 35 HCC patients comorbid with esophagogastric variceal bleeding who were admitted to Zengcheng Branch of Nanfang Hospital， Southern Medical University， and were treated with TIPS from July 2019 to April 2023. The Kaplan-Meier curve was used to assess rebleeding rate and survival rate after TIPS， and the Cox regression model was used to investigate the influencing factors for postoperative rebleeding and survival.  Results  The TIPS procedure was technically successful in all patients， with a median follow-up time of 16.4 months. During follow-up， 11 patients （31.4%） experienced esophagogastric variceal rebleeding， with the 1-month， 3-month， and 1-year rebleeding rates of 5.7%， 17.1%， and 28.6%， respectively. White blood cell count （WBC） （risk ratio ［HR］=1.31， 95% confidence interval ［CI］： 1.04 ‍—‍ 1.64， P=0.021）， number of tumors ≥3 （HR=35.68， 95%CI： 1.74 ‍—‍ 733.79， P=0.021）， and portal pressure gradient before TIPS （HR=0.85， 95%CI： 0.73 ‍—‍ 0.99， P=0.032） were independent predictive factors for rebleeding after TIPS. Shunt dysfunction was observed in 5 patients after surgery. A total of 19 patients died during follow-up， with a median survival time of 9.6 months. Portal vein tumor thrombosis （PVTT） （HR=7.04， 95%CI： 1.31 ‍—‍ 37.78， P=0.023）， total bilirubin （TBil） （HR=1.02， 95%CI： 1.00 ‍—‍ 1.03， P=0.042）， and serum albumin （HR=0.82， 95%CI： 0.72 ‍—‍ 0.94， P=0.004） were independent predictive factors for survival after TIPS.  Conclusion  TIPS procedure can be used as a therapeutic option to prevent esophagogastric variceal rebleeding in patients with HCC. Patients with a relatively high level of WBC or TBil or those with PVTT tend to have a poorer prognosis， and the application of TIPS treatment in such patients should be determined with caution.

     

    • FullText(HTML)
  • loading
    • References(32)
  • [1]
    GINÈS P, KRAG A, ABRALDES JG, et al. Liver cirrhosis[J]. Lancet, 2021, 398( 10308): 1359- 1376. DOI: 10.1016/S0140-6736(21)01374-X.
    [2]
    European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol, 2018, 69( 2): 406- 460. DOI: 10.1016/j.jhep.2018.03.024.
    [3]
    de FRANCHIS R, FACULTY BV. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension[J]. J Hepatol, 2015, 63( 3): 743- 752. DOI: 10.1016/j.jhep.2015.05.022.
    [4]
    GIANNINI EG, RISSO D, TESTA R, et al. Prevalence and prognostic significance of the presence of esophageal varices in patients with hepatocellular carcinoma[J]. Clin Gastroenterol Hepatol, 2006, 4( 11): 1378- 1384. DOI: 10.1016/j.cgh.2006.08.011.
    [5]
    GARCIA-TSAO G, ABRALDES JG, BERZIGOTTI A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65( 1): 310- 335. DOI: 10.1002/hep.28906.
    [6]
    DARIUSHNIA SR, HASKAL ZJ, MIDIA M, et al. Quality improvement guidelines for transjugular intrahepatic portosystemic shunts[J]. J Vasc Interv Radiol, 2016, 27( 1): 1- 7. DOI: 10.1016/j.jvir.2015.09.018.
    [7]
    LIU L, ZHAO Y, QI XS, et al. Transjugular intrahepatic portosystemic shunt for symptomatic portal hypertension in hepatocellular carcinoma with portal vein tumor thrombosis[J]. Hepatol Res, 2014, 44( 6): 621- 630. DOI: 10.1111/hepr.12162.
    [8]
    ZHOU J, SUN HC, WANG Z, et al. Guidelines for the diagnosis and treatment of primary liver cancer(2022 edition)[J]. Liver Cancer, 2023, 12( 5): 405- 444. DOI: 10.1159/000530495.
    [9]
    LYU Y, FAN DM, HAN GH. Application status and future prospect of transjugular intrahepatic portosystemic shunt in gastroesophageal variceal bleeding in liver cirrhosis[J]. J Clin Hepatol, 2022, 38( 6): 1229- 1233. DOI: 10.3969/j.issn.1001-5256.2022.06.004.

    吕勇, 樊代明, 韩国宏. 经颈静脉肝内门体分流术在肝硬化食管胃底静脉曲张破裂出血中的应用现状与未来展望[J]. 临床肝胆病杂志, 2022, 38( 6): 1229- 1233. DOI: 10.3969/j.issn.1001-5256.2022.06.004.
    [10]
    GUPTA VF, AGASSI A, MARTIN JG, et al. Intravascular ultrasound guidance for transjugular intrahepatic portosystemic shunt creation reduces laboratory markers of acute liver injury[J]. J Vasc Interv Radiol, 2023, 34( 10): 1680- 1689. e 2. DOI: 10.1016/j.jvir.2023.06.034.
    [11]
    ZHANG XW, TSAUO J, TIE J, et al. Emergent transjugular intrahepatic portosystemic shunt creation for acute gastric variceal bleeding in patients with hepatocellular carcinoma[J]. J Vasc Interv Radiol, 2022, 33( 6): 702- 706. DOI: 10.1016/j.jvir.2022.03.012.
    [12]
    TSAUO J, TIE J, XUE H, et al. Transjugular intrahepatic portosystemic shunt creation for the prevention of gastric variceal rebleeding in patients with hepatocellular carcinoma: A multicenter retrospective study[J]. J Vasc Interv Radiol, 2021, 32( 7): 963- 969. DOI: 10.1016/j.jvir.2021.04.005.
    [13]
    LIU JC, MA JQ, ZHOU C, et al. Potential benefits of underdilation of 8-mm covered stent in transjugular intrahepatic portosystemic shunt creation[J]. Clin Transl Gastroenterol, 2021, 12( 6): e00376. DOI: 10.14309/ctg.0000000000000376.
    [14]
    CAO LM, ZHANG YX, LIANG ZH, et al. Clinical efficacy of repeated TACE combined with TIPS in treatment of patients with hepatocellular carcinoma complicated by liver cirrhosis and upper gastrointestinal bleeding[J]. Clin Misdiagn Misther, 2022, 35( 2): 39- 43. DOI: 10.3969/j.issn.1002-3429.2022.02.010.

    曹莉明, 张勇学, 梁志会, 等. 多次TACE联合TIPS治疗肝癌合并肝硬化上消化道出血的临床效果[J]. 临床误诊误治, 2022, 35( 2): 39- 43. DOI: 10.3969/j.issn.1002-3429.2022.02.010.
    [15]
    Chinese Society of Spleen and Portal Hypertension Surgery, Chinese Society of Surgery, Chinese Medical Association. Chinese expert consensus on clinical diagnosis and treatment of portal hypertension with hepatocellular carcinoma(2022 edition)[J]. Chin J Dig Surg, 2022, 21( 4): 444- 455. DOI: 10.3760/cma.j.cn115610-20220223-00104.

    中华医学会外科学分会脾及门静脉高压外科学组. 门静脉高压合并肝细胞癌临床诊断与治疗中国专家共识(2022版)[J]. 中华消化外科杂志, 2022, 21( 4): 444- 455. DOI: 10.3760/cma.j.cn115610-20220223-00104.
    [16]
    WU WY, ZHANG FM, MEI XC, et al. Balloon-compression endoscopic injection sclerotherapy versus transjugular intrahepatic portosystemic shunt for esophageal variceal rebleeding[J]. Surg Endosc, 2023, 37( 7): 5766- 5774. DOI: 10.1007/s00464-023-10085-y.
    [17]
    XUE H, ZHANG M, PANG JX, et al. Transjugular intrahepatic portosystemic shunt vs endoscopic therapy in preventing variceal rebleeding[J]. World J Gastroenterol, 2012, 18( 48): 7341- 7347. DOI: 10.3748/wjg.v18.i48.7341.
    [18]
    LIU JC, SHI Q, XIAO SP, et al. Using transjugular intrahepatic portosystemic shunt as the first-line therapy in secondary prophylaxis of variceal hemorrhage[J]. J Gastroenterol Hepatol, 2020, 35( 2): 278- 283. DOI: 10.1111/jgh.14761.
    [19]
    RIPOLL C, GENESCÀ J, ARAUJO IK, et al. Rebleeding prophylaxis improves outcomes in patients with hepatocellular carcinoma. A multicenter case-control study[J]. Hepatology, 2013, 58( 6): 2079- 2088. DOI: 10.1002/hep.26629.
    [20]
    AUGUSTIN S, MUNTANER L, ALTAMIRANO JT, et al. Predicting early mortality after acute variceal hemorrhage based on classification and regression tree analysis[J]. Clin Gastroenterol Hepatol, 2009, 7( 12): 1347- 1354. DOI: 10.1016/j.cgh.2009.08.011.
    [21]
    CHEN J, TSENG Y, LUO TC, et al. Prophylactic endoscopic therapy for variceal bleeding in patients with hepatocellular carcinoma[J]. J Cancer, 2019, 10( 14): 3087- 3093. DOI: 10.7150/jca.30434.
    [22]
    LEE YR, PARK SY, TAK WY. Treatment outcomes and prognostic factors of acute variceal bleeding in patients with hepatocellular carcinoma[J]. Gut Liver, 2020, 14( 4): 500- 508. DOI: 10.5009/gnl19155.
    [23]
    KAWAI T, YASHIMA Y, SUGIMOTO T, et al. Emergency endoscopic variceal ligation following variceal rupture in patients with advanced hepatocellular carcinoma and portal vein tumor thrombosis: A retrospective study[J]. World J Surg Oncol, 2016, 14: 52. DOI: 10.1186/s12957-016-0802-z.
    [24]
    LIANG XX, HE LL, YANG JR, et al. Risk factors of rebleeding after endoscopic treatment of patients with portal vein tumor thrombus and esophagogastric variceal bleeding[J]. J Clin Hepatol, 2022, 38( 10): 2290- 2295. DOI: 10.3969/j.issn.1001-5256.2022.10.017.

    梁秀霞, 何玲玲, 杨君茹, 等. 内镜治疗肝细胞癌合并门静脉癌栓患者食管胃静脉曲张出血后再出血的危险因素分析[J]. 临床肝胆病杂志, 2022, 38( 10): 2290- 2295. DOI: 10.3969/j.issn.1001-5256.2022.10.017.
    [25]
    CHANG CJ, HOU MC, LIAO WC, et al. Risk factors of early re-bleeding and mortality in patients with ruptured gastric varices and concomitant hepatocellular carcinoma[J]. J Gastroenterol, 2012, 47( 5): 531- 539. DOI: 10.1007/s00535-011-0518-3.
    [26]
    WALLACE M, SWAIM M. Transjugular intrahepatic portosystemic shunts through hepatic neoplasms[J]. J Vasc Interv Radiol, 2003, 14( 4): 501- 507. DOI: 10.1097/01.rvi.0000064846.87207.ab.
    [27]
    FONIO P, DISCALZI A, CALANDRI M, et al. Incidence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt(TIPS) according to its severity and temporal grading classification[J]. Radiol Med, 2017, 122( 9): 713- 721. DOI: 10.1007/s11547-017-0770-6.
    [28]
    LIU MY, LI WZ, LI PJ, et al. Comparison of endoscopic therapy and TIPS in prophylaxis and treatment of variceal bleeding in decompensated portal hypertension[J]. J Clin Hepatol, 2023, 39( 7): 1529- 1534. DOI: 10.3969/j.issn.1001-5256.2023.07.003.

    刘梦莹, 李伟之, 李培杰, 等. 失代偿期门静脉高压并发食管胃静脉曲张出血的防治: 内镜vs经颈静脉肝内门体分流术[J]. 临床肝胆病杂志, 2023, 39( 7): 1529- 1534. DOI: 10.3969/j.issn.1001-5256.2023.07.003.
    [29]
    ZHENG MH, CHEN YP, BAI JL, et al. Transjugular intrahepatic portosystemic shunt versus endoscopic therapy in the secondary prophylaxis of variceal rebleeding in cirrhotic patients: Meta-analysis update[J]. J Clin Gastroenterol, 2008, 42( 5): 507- 516. DOI: 10.1097/MCG.0b013e31815576e6.
    [30]
    BAI M, QI XS, YANG ZP, et al. Predictors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients: A systematic review[J]. J Gastroenterol Hepatol, 2011, 26( 6): 943- 951. DOI: 10.1111/j.1440-1746.2011.06663.x.
    [31]
    NARDELLI S, GIOIA S, PASQUALE C, et al. Cognitive impairment predicts the occurrence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt[J]. Am J Gastroenterol, 2016, 111( 4): 523- 528. DOI: 10.1038/ajg.2016.29.
    [32]
    BERLIOUX P, ROBIC MA, POIRSON H, et al. Pre-transjugular intrahepatic portosystemic shunts(TIPS) prediction of post-TIPS overt hepatic encephalopathy: The critical flicker frequency is more accurate than psychometric tests[J]. Hepatology, 2014, 59( 2): 622- 629. DOI: 10.1002/hep.26684.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(3)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (355) PDF downloads(24) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return