Original Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 14, 2011; 17(10): 1267-1275
Published online Mar 14, 2011. doi: 10.3748/wjg.v17.i10.1267
Portal vein thrombosis and arterioportal shunts: Effects on tumor response after chemoembolization of hepatocellular carcinoma
Thomas J Vogl, Nour-Eldin Nour-Eldin, Sally Emad-Eldin, Nagy NN Naguib, Joerg Trojan, Hans Ackermann, Omar Abdelaziz
Thomas J Vogl, Nour-Eldin Nour-Eldin, Nagy NN Naguib, Joerg Trojan, Hans Ackermann, Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
Sally Emad-Eldin, Omar Abdelaziz, Diagnostic and Interventional Radiology Department, Cairo University Hospital, Cairo, Egypt
Author contributions: Vogl TJ, Nour-Eldin NE and Abdelaziz O contributed equally to this work; Vogl TJ, Nour-Eldin NE and Abdelaziz O designed research; Vogl TJ, Nour-Eldin NE and Abdelaziz O performed research; Emad-Eldin S, Naguib NNN, Trojan J contributed new analytic tools; Vogl TJ, Nour-Eldin NE, Abdelaziz O, Emad-Eldin S, Naguib NNN, Trojan J and Ackermann H analyzed data; and Vogl TJ, Nour-Eldin NE and Abdelaziz O wrote the paper.
Correspondence to: Dr. Nour-Eldin Nour-Eldin, MD, Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe University Hospital, Theodor-Stern-Kai Street 7, 60590 Frankfurt am Main, Germany. nour410@hotmail.com
Telephone: +49-69-63017278 Fax: +49-69-63017258
Received: September 14, 2010
Revised: November 11, 2010
Accepted: November 18, 2010
Published online: March 14, 2011
Abstract

AIM: To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization.

METHODS: A retrospective study included 39 patients (mean age: 66.4 years, range: 45-79 years, SD: 7) with unresectable hepatocellular carcinoma (HCC) who were treated with repetitive transarterial chemoembolization (TACE) in the period between March 2006 and October 2009. The effect of portal vein thrombosis (PVT) (in 19 out of 39 patients), the presence of arterioportal shunt (APS) (in 7 out of 39), the underlying liver pathology, Child-Pugh score, initial tumor volume, number of tumors and tumor margin definition on imaging were correlated with the local tumor response after TACE. The initial and end therapy local tumor responses were evaluated according to the response evaluation criteria in solid tumors (RECIST) and magnetic resonance imaging volumetric measurements.

RESULTS: The treatment protocols were well tolerated by all patients with no major complications. Local tumor response for all patients according to RECIST criteria were partial response in one patient (2.6%), stable disease in 34 patients (87.1%), and progressive disease in 4 patients (10.2%). The MR volumetric measurements showed that the PVT, APS, underlying liver pathology and tumor margin definition were statistically significant prognostic factors for the local tumor response (P = 0.018, P = 0.008, P = 0.034 and P = 0.001, respectively). The overall 6-, 12- and 18-mo survival rates from the initial TACE were 79.5%, 37.5% and 21%, respectively.

CONCLUSION: TACE may be exploited safely for palliative tumor control in patients with advanced unresectable HCC; however, tumor response is significantly affected by the presence or absence of PVT and APS.

Keywords: Hepatocellular carcinoma; Transarterial chemoembolization; Portal; Shunt; Thrombosis