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Hepatocellular Carcinoma Invading the Main Portal Vein: Treatment with Transcatheter Arterial Chemoembolization and Portal Vein Stenting

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Abstract

To retrospectively analyze the therapeutic results of percutaneous transhepatic portal vein stenting (PTPVS) and transcatheter arterial chemoembolization (TACE) treatment in 58 patients with hepatocellular carcinoma (HCC) invading the main portal vein (MPV). A total of 58 procedures of PTPVS were performed, immediately after which TACE was undertaken to control HCC. The clinical effects, complications, digital subtraction angiographic appearance, stent patency rates, cumulative survival rates, and predictive factors for survival were evaluated. The Kaplan–Meyer method and the log rank test were used for survival analysis. Multivariable analysis was also conducted by the Cox proportional hazard model. No patient died during stent placement or within the first 24 h. No severe procedure-related complications were observed. After stent placement, the mean ± standard deviation portal venous pressure levels decreased from 41.43 ± 8.56 cmH2O to 37.19 ± 7.89 cmH2O (p < 0.01). At the time of analysis, 9 of the 58 patients survived. The 60-, 180-, 360-, and 720-day cumulative patency rates were 98.1%, 71.0%, 52.6%, and 42.1%, respectively, with a mean patency time of 552.9 ± 88.2 days and a median patency time of 639.00 ± 310.00 (95% confidence interval [95% CI], 31.40–1246.60) days. The 60-, 180-, 360-, and 720-day cumulative survival rates for the total study population were 74.1%, 27.1%, 17.2%, and 13.8%, respectively, with a median survival time of 113 ± 27.29 (95% CI, 59.51–166.49) days. In the univariate analysis, the following six variables were significantly associated with the prognosis: (1) HCC type; (2) Child-Pugh grade; (3) MPV stenosis/occlusion; (4) arteriovenous shunt; (5) iodized oil deposition; and (6) number of TACE procedure. In addition, having diffuse-type HCC and Child-Pugh grade B disease were each independent factors associated with decreased survival time in the multivariate analysis. PTPVS-TACE is feasible and may be useful to control HCC invading the MPV.

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Abbreviations

TACE:

Transcatheter arterial chemoembolization

PTPVS:

Percutaneous transhepatic portal vein stenting

HCC:

Hepatocellular carcinoma

MPV:

Main portal vein

AVS:

Arteriovenous shunt

AFP:

Alpha fetoprotein

DSA:

Digital substraction angiography

PTPE:

Percutaneous transhepatic portographic embolization

PTCD:

Percutaneous transhepatic cholangial drainage

CT:

Computed tomography

US:

Ultrasonography

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Acknowledgments

The authors contributed to this article in the following ways: Guarantors of integrity of entire study, J.H.W., X.B.Z.; study concepts and design, J.H.W., Z.P.Y., S.Q.; literature research, X.B.Z, J.H.W.; clinical studies, all authors; data acquisition, J.H.W, X.B.Z., S.Q.; data analysis/interpretation, all authors; statistical analysis, all authors; manuscript preparation, X.B.Z, J.H.W.; manuscript definition of intellectual content, editing, revision/review, and final version approval, all authors.

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  1. Department of Radiology, Zhong Shan Hospital, Fudan University, Fenglin Road, Shanghai, 200032, People’s Republic of China

    Xue-Bin Zhang, Jian-Hua Wang, Zhi-Ping Yan, Sheng Qian & Rong Liu

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  1. Xue-Bin Zhang
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  2. Jian-Hua Wang
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Correspondence to Jian-Hua Wang.

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Zhang, XB., Wang, JH., Yan, ZP. et al. Hepatocellular Carcinoma Invading the Main Portal Vein: Treatment with Transcatheter Arterial Chemoembolization and Portal Vein Stenting. Cardiovasc Intervent Radiol 32, 52–61 (2009). https://doi.org/10.1007/s00270-008-9454-x

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  • DOI: https://doi.org/10.1007/s00270-008-9454-x

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