Feasibility and clinical value of TIPS combined with subsequent antitumor treatment in HCC patients with refractory ascites

Yan, Huzheng; Wang, Guobao; Zhu, Wenliang; Feng, Kai; Zhu, Wei; Wu, Xuan; Qiu, Zhenkang; Chen, Guan-Yu; Jiang, Weiwei; Zhang, Fujun; Gao, Fei

doi:10.1016/j.tranon.2020.100864

Cited by 9 publications

(5 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All 11 studies (Table 1 ) were retrospective of low to medium quality (Supplementary Table 1 ) and in total included 937 patients, 870 of which with TIPS placement after the diagnosis of HCC to treat the complications. 13 , 14 , 15 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 Most studies originated from China and the majority had hepatitis B virus‐associated cirrhosis and/or alcohol‐related disease. Patients were mostly male (range: 57.9%–100%) and the mean age ranged from 46.3 to 63.5 years.…”

Section: Resultsmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt in patients with hepatocellular carcinoma: A systematic review

Norero,

Bosch,

Berzigotti

et al. 2023

UEG Journal

View full text Add to dashboard Cite

Background/AimsTransjugular intrahepatic portosystemic shunts (TIPS) in patients with hepatocellular carcinoma (HCC) may improve access to curative therapies, treat portal hypertension (PH)‐related complications without worsening liver function, and increase overall survival. Data on the efficacy and safety of TIPS to treat PH complications in HCC patients, as well as the HCC treatment response, were evaluated.MethodsStudies reporting efficacy in controlling bleeding/ascites or response to HCC therapy, safety, and survival in patients with HCC and TIPS were searched systematically on PubMed and Embase. An extraction of articles using predefined data fields and quality indicators was used.ResultsWe selected 19 studies and found 937 patients treated for ascites/bleeding and 177 evaluating HCC treatment response. Over half were under 5 cm and solitary lesions, and most studies included tumours with portal vein thrombosis. Regarding PH studies, TIPS resolved bleeding/ascites in >60% of patients, more effective for bleeding. There were no lethal complications reported and procedural bleeding occurred in <5%. Hepatic encephalopathy occurred in 15%–30% within three months. In the HCC treatment‐response studies, major complication rates were low with no mortality. In the studies that evaluated the response to transarterial chemoembolization, complete response rate of patients with TIPS varied from 16% to 75%. Liver transplantation rate varied from 8% to 80%, with >40% rate in half of the studies.ConclusionsIn the published studies, TIPS is effective in treating PH complications in patients with HCC. Prospective studies on TIPS placement in patients with HCC are urgently needed to evaluate the efficacy and safety of TIPS in this setting.

show abstract

Section: Resultsmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt in patients with hepatocellular carcinoma: A systematic review

Norero,

Bosch,

Berzigotti

et al. 2023

UEG Journal

View full text Add to dashboard Cite

show abstract

“…In a multicentric study, Huzheng Yan et al [ 27 ] enrolled 68 patients with HCC and portal-hypertension-related refractory ascites. After TIPS implantation, patients were reassessed with the Child–Pugh score and evaluated for anti-HCC treatment.…”

Section: Tips and Locoregional Treatments: Transarterial Chemoemboliz...mentioning

confidence: 99%

“…Recently, a Chinese group of researchers proposed a new flowchart for the downstaging of refractory ascites through the use of antitumor therapy. This flowchart is based on the new BCLC staging: 47.1% of this small cohort of enrolled patients received systemic therapy (namely, sorafenib, lenvatinib, or apatinib) and showed the feasibility and effectiveness of this new sequential treatment of HCC [ 27 ]. Interestingly, the modified step-by-step approach may shorten the distance between BCLC-C and BCLC-D due to CSPH and may extend survival time of patients (from 3 months to 2 years) [ 11 ].…”

Section: Tips Use As a Bridge To Systemic Therapymentioning

confidence: 99%

The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Treating Portal Hypertension in Patients with Hepatocellular Carcinoma

et al. 2023

View full text Add to dashboard Cite

Liver cancer is very frequent, and hepatocellular carcinoma (HCC) accounts for the majority of liver cancer cases. Its growing incidence has been greatly affected by the increasing prevalence of metabolic-associated fatty liver disease (MAFLD). The latter is a new epidemic in our era. In fact, HCC is often generated from noncirrhotic liver and its treatment benefits from surgical and nonsurgical approaches, potentially bridged by transjugular intrahepatic portosystemic shunt (TIPS) use. TIPS use is an effective treatment for portal hypertension complications, but its application in patients with HCC and clinically significant portal hypertension (CSPH) remains controversial due to concerns about tumor rupture, dissemination, and increased toxicity. The technical feasibility and safety of TIPS use in HCC patients have been evaluated in several studies. Despite concerns about intraprocedural complications, retrospective studies have shown high success rates and low complication rates in TIPS placement for HCC patients. TIPS use in combination with locoregional treatments, such as transarterial chemoembolization (TACE) or transarterial radioembolization (TARE), has been explored as a treatment option for HCC patients with portal hypertension. These studies have shown improved survival rates in patients undergoing TIPS in combination with locoregional treatments. However, the efficacy and toxicity of TACE in combination with TIPS use require careful evaluation, as changes in venous and arterial flow can affect treatment outcomes and complications. The results from studies evaluating the impact of TIPS on systemic therapy and surgical options are also promising. In conclusion, the TIPS is a sufficiently safe, useful item available for physicians treating complications of portal hypertension. Moreover, a TIPS can be used in combination with locoregional therapy in HCC patients. Systemic chemotherapy can also benefit of the use of TIPS placement. A complex interplay affects TIPS use with surgery. The latter needs further data. The TIPS is a useful and safe add-on treatment, changing the natural course of HCC progression. Its use is regulated by a sophisticated physiologic and pathophysiologic flow of evidence.

show abstract

“…Improvements in CTP scores increase the chances of receiving treatments for HCC, which lead to a survival benefit. 55 TACE, the major treatment modality for HCC, can cause hepatic ischemia through arterial embolization; thus, liver perfusion can be further reduced following TACE in patients with TIPS, which diverts the portal venous inflow. A previous study showed that TACE with drug-eluting beads in HCC patients with TIPS significantly reduced the incidence of hepatotoxicity after TACE and improved the overall survival rate relative to that of conventional TACE.…”

Section: Hepatocellular Carcinomamentioning

confidence: 99%

“…In a small number of HCC patients with refractory ascites, TIPS implementation improved CTP scores in 78% of the study population, mainly by controlling ascites. Improvements in CTP scores increase the chance of receiving treatments for HCC, which leads to a survival benefit [ 54 ]. TACE, a major treatment modality for HCC, can cause hepatic ischemia through arterial embolization; therefore, liver perfusion can be further reduced after TACE in patients with TIPS, which diverts the portal venous inflow.…”

Section: Indicationsmentioning

confidence: 99%

The role of transjugular intrahepatic portosystemic shunt in patients with portal hypertension: Advantages and pitfalls

Lee

2022

Clin Mol Hepatol

View full text Add to dashboard Cite

Transjugular intrahepatic portosystemic shunt (TIPS) is an effective interventional procedure to relieve portal hypertension, which is the main mechanism for the development of complications of liver cirrhosis (LC), including variceal hemorrhage, ascites, and hepatorenal syndrome. However, the high incidence of adverse events after TIPS implementation limits its application in clinical practice. Esophageal variceal hemorrhage is one of the major indications for TIPS. Recently, preemptively performed TIPS has been recommended as several studies have demonstrated that TIPS significantly reduced mortality as well as rebleeding or failure to control bleeding in patients who are at high risk of treatment failure for bleeding control with endoscopic variceal ligation and vasoactive drugs. Meanwhile, recurrent ascites is another indication for TIPS with a proven survival benefit. TIPS may also be considered as an effective treatment for other LC complications, usually as an alternative therapy. Although there are concerns about the development of hepatic encephalopathy and hepatic dysfunction after TIPS implementation, careful patient selection using prognostic scores can lead to excellent outcomes. Assessments of cardiac and renal function prior to TIPS may also be considered to improve patient prognosis.

show abstract

Feasibility and clinical value of TIPS combined with subsequent antitumor treatment in HCC patients with refractory ascites

Cited by 9 publications

References 28 publications

Transjugular intrahepatic portosystemic shunt in patients with hepatocellular carcinoma: A systematic review

Transjugular intrahepatic portosystemic shunt in patients with hepatocellular carcinoma: A systematic review

The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Treating Portal Hypertension in Patients with Hepatocellular Carcinoma

The role of transjugular intrahepatic portosystemic shunt in patients with portal hypertension: Advantages and pitfalls

Contact Info

Product

Resources

About