https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.31646

Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases.

Management of patients with hepatocellular carcinoma and portal vein tumour thrombosis: comparing east and west.

The incidence and outcome of major complication following conventional TAE/TACE for hepatocellular carcinoma

https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajt.15559

The decreasing predictive power of MELD in an era of changing etiology of liver disease.

Conventional transcatheter arterial chemoembolization (c-TACE) is a widely used first-line palliative treatment for patients with unresectable hepatocellular carcinoma (HCC). Despite the effectiveness of c-TACE, to date, technique and procedure scheduling has not yet been standardized. Drug-eluting microspheres (DEMs) were therefore introduced to ensure more sustained and tumor-selective drug delivery for permanent embolization. These DEMs can load various drugs and release them in a sustained manner over a prolonged period. This approach ensures the delivery of high concentrations of chemotherapeutic agents to tumors, without increasing systemic concentrations, and promote tumor ischemia and necrosis. This review summarizes the recent advances in the use of DEM-TACE to treat HCC.

https://pc.kjronline.org/Synapse/Data/PDFData/0068KJR/kjr-20-34.pdf

Update on Transarterial Chemoembolization with Drug-Eluting Microspheres for Hepatocellular Carcinoma

Liver Abscess Formation Following Transarterial Chemoembolization: Clinical Features, Risk Factors, Bacteria Spectrum, and Percutaneous Catheter Drainage

Background: Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD) scores have been used commonly to predict the survival in the patients with liver diseases underwent transjugular intrahepatic portosystemic shunt (TIPS). However, a debate has continued for years whether CTP could be replaced by MELD score. We performed a systematic meta-analytic review to compare the prediction capability of both scores in survival among patients with TIPS. Methods: Retrospective cohort studies among patients with TIPS were published as of May 2013 were identified by systematically searching four electronic literature database, such as Ovid Medline, PubMed, EMBASE, and ISI Web of Science. The difference of standardized mean difference (SMD) of c-statistics for the predictive accuracy of 1-, 3-, 6-, and 12-month survival for both MELD and CP scores, defined as effect size (ES), was calculated for each individual study and then pooled across studies using standard meta-analyses with a random effects model. Publication bias was evaluated using funnel plots and Kendall’s rank correlation tests. Results: 174 researches articles or conference abstracts were searched and reviewed using the combination of relevant terms in the articles. Finally, 11 articles were defined as eligible studies to evaluate simultaneously the predictive accuracy of MELD and CTP scores. In the meta-analyses, MELD score was superior to CP score in predicting 3-month survival after TIPS (mean ES, 0.63; 95% confidence interval [CI], 0.13-1.14; P=0.01), but the predictive capability in 1-month, 6-month, and 12-month survival was not significant (1-month: mean ES, 0.79; 95% CI, -0.24-1.83; P=0.13; 6-month: mean ES, 0.46; 95% CI, -2.46-3.37; P=0.76; 12-month: mean ES, 0.36; 95% CI, -0.25-0.96; P=0.25). Conclusions: No enough evidence are confirmed so far that MELD score is better than CTP score to assess the overall prognosis after TIPS, especially long-term predictions, but 3-month predictive capability of MELD score significantly outperform CTP score.

https://www.ijcem.com/files/ijcem0010964.pdf

Predictive accuracy comparison of MELD and Child-Turcotte-Pugh scores for survival in patients underwent TIPS placement: a systematic meta-analytic review.

Magnetic resonance imaging (MRI) is able to diagnose Budd–Chiari syndrome (BCS) by distinguishing differential imaging features of acute and chronic forms of the disease. However, the characteristic imaging differences are still not clear as previous data were mostly obtained from scattered small samples instead of large comparative study. To investigate MRI manifestations of acute and chronic (BCS), and to evaluate the value of MRI for diagnosis of acute and chronic BCS. We retrospectively compared MRI results of 24 patients with acute and 82 patients with chronic BCS using Mann–Whitney U test for ascites volume, and Fisher’s exact test for intrahepatic venous collaterals and extra-hepatic venous collaterals. In the acute group, MRI findings suggested thrombosis in hepatic vein (HV) in all acute patients and additional inferior vena cava (IVC) thrombosis in 5 patients. In the chronic BCS group, 6 and 15 patients showed solitary obstruction either in the IVC or HV, respectively, while 61 patients showed combined IVC and HV obstruction. More patients with acute BCS presented with ascites accompanied with high signals on T2WI from intravenous obstructive lesions. Further, the average maximal spleen diameter in patients with acute BCS, and the ratio of patients with acute BCS developing intrahepatic venous collaterals and extra-hepatic venous collaterals were also lower compared with chronic BCS. All these differences were statistically significant. MRI indicates direct and indirect features of BCS, and therefore enables accurate diagnosis of acute and chronic BCS.

Comparative study of MRI manifestations of acute and chronic Budd-Chiari syndrome.

Objectives To explore the efficacy and influencing factors of transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) combined with portal vein tumor thrombosis (PVTT). Materials and methods The clinical data of 3,126 consecutive patients who suffered from advanced HCC and underwent TACE were retrospectively analyzed. A total of 685 patients had a combination of HCC and PVTT. Of these patients, 475 were treated with TACE (Group A) and 210 were given a supportive care (Group B). The local response and overall survival of the two groups were observed and compared, and the influencing factors were examined through Cox regression analysis. Results The median survival time and cumulative survival rate at 6, 12, and 24 months of Group A were higher than those of Group B (P=0.002). Multiple Cox regression analysis revealed that Child-Pugh classes and PVTT grades were the independent prognostic factors affecting a patient's survival. Stratified analysis demonstrated that the survival time of patients diagnosed with grades I/II PVTT and treated with TACE was superior to that of patients provided with supportive care (P=0.001), but the survival time of patients with grades III/IV PVTT with or without TACE did not significantly differ (P=0.662). Conclusion TACE can significantly improve local response, increase cumulative survival rate, and prolong the survival duration of patients with HCC and grades I/II PVTT, whereas the efficacy of TACE for patients with grades III/IV PVTT should be further verified, although their local responses were improved. Child-Pugh classes and PVTT grades are essential factors influencing patient prognosis.

/pdf/transarterial-chemoembolization-for-hepatocellular-carcinoma-2ndid3z7m2.pdf

Transarterial chemoembolization for hepatocellular carcinoma combined with portal vein tumor thrombosis

Purpose Transcatheter arterial chemoembolization (TACE) and targeted therapy have become common methods in the treatment of advanced hepatocellular carcinoma (HCC). The purpose of this study was to evaluate the safety and efficacy of TACE combined with sorafenib (TACE-sorafenib) and TACE alone for the treatment of Barcelona clinical stage C HCC. Methods The clinical data of 75 patients with BCLC stage C HCC who received TACE-sorafenib or TACE as the initial treatment were retrospectively analyzed. Tumor response, time to progression (TTP), overall survival (OS), and adverse events were compared at 1 month after surgery in the two groups. Results One month after treatment, the disease control rate in the TACE-sorafenib group was higher than that in the TACE group alone (82.76% and 57.50%, respectively, P = 0.018). The median values of TTP and OS in the TACE-sorafenib group were longer than those in the TACE group (TTP was 7.6 and 3.4 months, respectively, P = 0.002; OS was 13.6 and 6.3 months, respectively, P = 0.041). The cumulative survival time at 3 months, 6 months, and 1 year was higher in the TACE-sorafenib group than in the TACE group (83.5%, 71.2%, 45.7% vs 57.4%, 40.6%, 21.2%). Sorafenib-related side effects such as hypertension, hand-foot syndrome, and oral ulcers were more common than those in the TACE group alone (P Conclusion Compared with TACE treatment alone, TACE combined with sorafenib in BCLC-C stage HCC significantly improved disease control rate, TTP, and OS, and no significant increase in adverse reactions was observed.

/pdf/transarterial-chemoembolization-combined-with-sorafenib-in-2toc5fzl1y.pdf

De-Lei Cheng

Papers

Liver Abscess Formation Following Transarterial Chemoembolization: Clinical Features, Risk Factors, Bacteria Spectrum, and Percutaneous Catheter Drainage

Predictive accuracy comparison of MELD and Child-Turcotte-Pugh scores for survival in patients underwent TIPS placement: a systematic meta-analytic review.

Comparative study of MRI manifestations of acute and chronic Budd-Chiari syndrome.

Transarterial chemoembolization for hepatocellular carcinoma combined with portal vein tumor thrombosis

Transarterial Chemoembolization Combined with Sorafenib in Patients with BCLC Stage C Hepatocellular Carcinoma.