Non selective beta-blockers prevent PHT-related complications occurrence in HCC patients with esophageal varices treated by TACE - 27/11/24
, Hélène Garcia c, Louis Meyblum d, Sarah Mouri a, Eléonore Spitzer a, Claire Goumard e, f, Olivier Lucidarme c, Marika Rudler a, f, Olivier Scatton e, f, Charles Roux d, Mathilde Wagner c, Dominique Thabut a, fHighlights |
• | The use of NSBBs has emerged as a potential strategy to prevent liver decompensation in compensated cirrhotic patients with CSPH |
• | Incidence of PHT complications was 18 % at 12 months after TACE (Ascites 16 %, AVB 3 % and HE 6 %) and was associated with significant higher mortality |
• | Among the patients, 34 % were not treated by NSBBs despite the presence of esophageal varices on upper endoscopy (i.e. CSPH), and inappropriate treatment by NSBBs was independently associated with PHT-related complications occurrence after TACE |
• | PHT-related complications occurrence precluded this access to further HCC treatment in 78 % patients who presented HCC progression |
• | Appropriate screening and CSPH prophylaxis is needed in HCC patients who undergo TACE to improve their outcome. |
Abstract |
Introduction |
We aimed to investigate the parameters associated with portal hypertension (PHT)-related complications occurrence in hepatocellular carcinoma (HCC) patients treated by transarterial chemoembolization (TACE), with a focus on non-selective beta blockers (NSBBs) due to their impact on preventing liver decompensation.
Methods |
We included all patients with HCC for whom endoscopy was available the day of first TACE (2013-2023). The occurrence of PHT-related complications was defined as the appearance of ascites, acute variceal bleeding or hepatic encephalopathy (HE) post-TACE treatment and prior to HCC progression. Inappropriate treatment by NSBBs was defined by the lack of NSBBs in patients with small/large esophageal varices (EV).
Results |
109 patients were included (age 67 years, 80 % male) and 65 % had EV. No NSBBs prescription despite indication was observed in 32 % and 81 % of patients with large and small size EV, respectively. Median progression free survival and overall survival were 10 and 23 months, respectively, and 27 % of patients underwent LT.
During the follow-up, 20 patients presented PHT-related complications with an incidence of 18 % at 12months (90 % with EV,67 % not treated by NSBB while indicated). Among them, 11 presented HCC progression, 2 were transplanted and 78 % presented liver decompensation that impaired the access to further HCC treatment. In multivariate analysis, a history of HE (HR=55.39,95 %CI[7.42-413.26]) and inappropriate NSBBs treatment (HR=4.16,95 %CI[1.45-11.81]) were associated with PHT-related complications occurrence.
Conclusion |
The lack of NSBBs was independently associated with PHT-related complications after TACE, precluding access to further HCC treatment in 78 % of patients with HCC progression. Appropriate screening and PHT prophylaxis are needed in HCC patients who undergo TACE to improve their outcomes.
Le texte complet de cet article est disponible en PDF.Key words : Hepatocellular carcinoma, Portal hypertension, TACE, Ascites
Plan
| ☆ | Financial support: None. |
| ☆☆ | Declaration of generative AI and AI-assisted technologies in the writing process (English corrector). |
Vol 49 - N° 1
Article 102496- janvier 2025 Retour au numéro
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