European Radiology

, Volume 28, Issue 5, pp 2184–2193 | Cite as

Portal hypertension is associated with poor outcome of transarterial chemoembolization in patients with hepatocellular carcinoma

  • Jin Woo Choi
  • Jin Wook Chung
  • Dong Ho Lee
  • Hyo-Cheol Kim
  • Saebeom Hur
  • Myungsu Lee
  • Hwan Jun Jae



To determine whether clinically relevant portal hypertension (CRPH) influences outcome and whether it may serve as a prognostic marker in patients treated with transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).


One hundred and forty-seven patients underwent conventional TACE as a first-line treatment for a single HCC. CRPH was graded as 0, 1, or 2. The influence of CRPH, together with other factors, on local tumour progression (LTP) and overall survival (OS) were analysed using Cox proportional hazards regression.


A higher CRPH grade (grade 1, p = 0.005, hazard ratio [HR] = 3.282; grade 2, p < 0.001, HR = 7.144) and less selective catheterization (p = 0.009, HR = 1.951) were significantly associated with early LTP. Regarding OS, older age, (p < 0.001, HR = 1.050), CRPH grade 2 (p = 0.024, HR = 2.058), and a larger tumour (p < 0.001, HR = 1.454) were significantly associated with early death.


Portal hypertension was significantly associated with poor outcome after TACE, and non-invasive CRPH grading may be a useful prognostic marker of TACE.

Key Points

Portal hypertension was significantly associated with poor outcome after TACE.

Grading portal hypertension non-invasively can help predict TACE outcome in HCC patients.

CRPH grading can aid in selecting optimal candidates for TACE.


Hepatocellular carcinoma Chemoembolization, therapeutic Portal hypertension Computed tomography, X-ray Survival 



Barcelona Clinic Liver Cancer


Confidence interval


Complete response


Clinically relevant portal hypertension


Computed tomography




Eastern Cooperative Oncology Group


Hepatocellular carcinoma


Hazard ratio


Hepatic venous pressure gradient


LT-censored OS


Liver transplantation


Local tumour progression


Magnetic resonance


Overall survival


Peribiliary plexus


Transarterial chemoembolization


Compliance with ethical standards


The scientific guarantor of this publication is Jin Wook Chung, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.


This study has received funding by the Korean Health Industry Development Institute (KHIDI), supported by the Ministry of Health & Welfare, Republic of Korea (Grant Number: HI15C2797).

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

No subjects / cohorts of this study have been previously reported.


• retrospective

• observational

• performed at one institution


  1. 1.
    Park JW, Chen M, Colombo M et al (2015) Global patterns of hepatocellular carcinoma management from diagnosis to death: the BRIDGE Study. Liver Int 35:2155–2166CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Llovet JM, Bru C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19:329–338CrossRefPubMedGoogle Scholar
  3. 3.
    Terzi E, Golfieri R, Piscaglia F et al (2012) Response rate and clinical outcome of HCC after first and repeated cTACE performed “on demand”. J Hepatol 57:1258–1267CrossRefPubMedGoogle Scholar
  4. 4.
    Kim BK, Kim SU, Kim KA et al (2015) Complete response at first chemoembolization is still the most robust predictor for favorable outcome in hepatocellular carcinoma. J Hepatol 62:1304–1310CrossRefPubMedGoogle Scholar
  5. 5.
    Bruix J, Sherman M, American Association for the Study of Liver Diseases (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    European Association for the Study of the Liver, European Organisation for Reresarch and Treatment of Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943CrossRefGoogle Scholar
  7. 7.
    Fernandez M (2015) Molecular pathophysiology of portal hypertension. Hepatology 61:1406–1415CrossRefPubMedGoogle Scholar
  8. 8.
    Poisson J, Lemoinne S, Boulanger C et al (2017) Liver sinusoidal endothelial cells: physiology and role in liver diseases. J Hepatol 66:212–227CrossRefPubMedGoogle Scholar
  9. 9.
    Iwakiri Y (2014) Pathophysiology of portal hypertension. Clin Liver Dis 18:281–291CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kim MY, Baik SK, Lee SS (2010) Hemodynamic alterations in cirrhosis and portal hypertension. Korean J Hepatol 16:347–352CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Kobayashi S, Nakanuma Y, Matsui O (1994) Histopathology of portal tracts in livers after transcatheter arterial chemo-embolization therapy for hepatocellular carcinoma. J Gastroenterol Hepatol 9:45–54CrossRefPubMedGoogle Scholar
  12. 12.
    Thabut D, Moreau R, Lebrec D (2011) Noninvasive assessment of portal hypertension in patients with cirrhosis. Hepatology 53:683–694CrossRefPubMedGoogle Scholar
  13. 13.
    American College of Radiology (2017) CT/MRI Liver Imaging Reporting and Data System (LI-RADS), version 2017. Available via Accessed 24 June 2017
  14. 14.
    Darnell A, Forner A, Rimola J et al (2015) Liver imaging reporting and data system with MR Imaging: evaluation in nodules 20 mm or smaller detected in cirrhosis at screening US. Radiology 275:698–707CrossRefPubMedGoogle Scholar
  15. 15.
    Choi JW, Cho HJ, Park JH et al (2014) Comparison of drug release and pharmacokinetics after transarterial chemoembolization using diverse lipiodol emulsions and drug-eluting beads. PLoS One 9:e115898CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kang HK, Jeong YY, Choi JH et al (2002) Three-dimensional multi-detector row CT portal venography in the evaluation of portosystemic collateral vessels in liver cirrhosis. Radiographics 22:1053–1061CrossRefPubMedGoogle Scholar
  17. 17.
    Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:52–60CrossRefPubMedGoogle Scholar
  18. 18.
    Gaba RC, Lewandowski RJ, Hickey R et al (2016) Transcatheter therapy for hepatic malignancy: standardization of terminology and reporting criteria. J Vasc Interv Radiol 27:457–473CrossRefPubMedGoogle Scholar
  19. 19.
    Ueda K, Matsui O, Kawamori Y et al (1998) Hypervascular hepatocellular carcinoma: evaluation of hemodynamics with dynamic CT during hepatic arteriography. Radiology 206:161–166CrossRefPubMedGoogle Scholar
  20. 20.
    Terayama N, Matsui O, Gabata T et al (2001) Accumulation of iodized oil within the nonneoplastic liver adjacent to hepatocellular carcinoma via the drainage routes of the tumor after transcatheter arterial embolization. Cardiovasc Intervent Radiol 24:383–387CrossRefPubMedGoogle Scholar
  21. 21.
    Miyayama S, Matsui O, Yamashiro M et al (2007) Ultraselective transcatheter arterial chemoembolization with a 2-f tip microcatheter for small hepatocellular carcinomas: relationship between local tumor recurrence and visualization of the portal vein with iodized oil. J Vasc Interv Radiol 18:365–376CrossRefPubMedGoogle Scholar
  22. 22.
    Miyayama S, Matsui O (2016) Superselective conventional transarterial chemoembolization for hepatocellular carcinoma: rationale, technique, and outcome. J Vasc Interv Radiol 27:1269–1278CrossRefPubMedGoogle Scholar
  23. 23.
    Sieghart W, Hucke F, Peck-Radosavljevic M (2015) Transarterial chemoembolization: modalities, indication, and patient selection. J Hepatol 62:1187–1195CrossRefPubMedGoogle Scholar
  24. 24.
    Bolondi L, Burroughs A, Dufour JF et al (2012) Heterogeneity of patients with intermediate (BCLC B) hepatocellular carcinoma: proposal for a subclassification to facilitate treatment decisions. Semin Liver Dis 32:348–359PubMedGoogle Scholar
  25. 25.
    Choi JW, Kim HC, Lee JH et al (2017) Transarterial chemoembolization of hepatocellular carcinoma with segmental portal vein tumour thrombus. Eur Radiol 27:1448–1458CrossRefPubMedGoogle Scholar
  26. 26.
    Choi TW, Kim HC, Lee JH et al (2015) The safety and clinical outcomes of chemoembolization in child-Pugh class C patients with hepatocellular carcinomas. Korean J Radiol 16:1283–1293CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Yang HJ, Lee JH, Lee DH et al (2014) Small single-nodule hepatocellular carcinoma: comparison of transarterial chemoembolization, radiofrequency ablation, and hepatic resection by using inverse probability weighting. Radiology 271:909–918CrossRefPubMedGoogle Scholar
  28. 28.
    Kadalayil L, Benini R, Pallan L et al (2013) A simple prognostic scoring system for patients receiving transarterial embolisation for hepatocellular cancer. Ann Oncol 24:2565–2570CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Hucke F, Pinter M, Graziadei I et al (2014) How to STATE suitability and START transarterial chemoembolization in patients with intermediate stage hepatocellular carcinoma. J Hepatol 61:1287–1296CrossRefPubMedGoogle Scholar
  30. 30.
    Julie Heimbach, Laura M Kulik, Richard Finn et al (2017) AASLD guidelines for the treatment of hepatocellular carcinoma. Available via Accessed 24 June 2017.

Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  1. 1.Section of Interventional Radiology, Department of Radiology, Seoul National University College of MedicineSeoul National University HospitalSeoulRepublic of Korea

Personalised recommendations