Long-Term Efficacy and Safety of Partial Splenic Embolization in Hepatocellular Carcinoma Patients with Thrombocytopenia Who Underwent Transarterial Chemoembolization

Abstract

Background Performing transarterial chemoembolization (TACE) is difficult with the occurrence of thrombocytopenia in cirrhotic patients with hepatocellular carcinoma (HCC). We aimed to evaluate the long-term efficacy and safety of partial splenic embolization (PSE) combined with TACE in patients with HCC with severe thrombocytopenia related to splenomegaly. Methods We conducted a case–control study consisting of 18 HCC patients with severe thrombocytopenia (< 50 × 10 9 /L) who underwent PSE concurrently with TACE (PSE group) and 72 controls who underwent TACE alone (non-PSE group). Results Mean platelet counts at 1 month and 1, 3, and 5 years after concurrent PSE and TACE significantly increased compared with baseline (all P < 0.05), whereas the platelet count did not significantly increase after TACE alone. In addition, the platelet count at several time points after treatment in the PSE group was significantly higher than that in the non-PSE group, although the baseline platelet count in the PSE group was significantly lower than that in the non-PSE group. The platelet increase after PSE significantly reduced the need for platelet transfusions ( P = 0.040) and enabled the subsequent TACE procedures in time ( P = 0.046). The leukocyte counts and hemoglobin concentrations after concurrent PSE and TACE were also significantly increased, without deterioration of Child-Turcotte-Pugh score and unexpected side effects. Conclusion PSE combined with TACE is effective in inducing and maintaining long-term thrombocytopenia improvement which reduces the need for the platelet transfusion and helps to perform initial and serial TACE, and is well-tolerated in patients with HCC and thrombocytopenia. PSE may be a promising treatment option for HCC patients with severe thrombocytopenia associated with splenomegaly who will undergo TACE.

Effect of partial splenic embolization on transarterial chemoembolization for hepatocellular carcinoma with hypersplenism

“…Hematological abnormalities caused by hypersplenism may limit HCC treatment options and delay the treatment implementation. [ 12 , 13 ] People with severe hypersplenism have a higher risk of varicose vein rupture and bleeding, and even death. [ 14 , 15 ] Still, the use of β-blockers or antibiotics for medical treatment of severe hypersplenism has no definite benefit, [ 15 ] making invasive treatment an important option for hypersplenism.…”

Is Partial Splenic Embolization a Good Option to Prevent Cirrhotic Complications in the Long Term?

“…The results from this study were positive to improve thrombocytopenia without significant adverse effects 1. However, it might need cautious interpretation of the results because of small study numbers at baseline and high rates of follow-up loss (36.7%) during the follow-up periods.…”

“…Regarding safety of PSE in this study, the Child-Turcotte-Pugh scores within 6 months after treatment in the PSE group were significantly higher than those in the non-PSE-group. However, there was no significant difference of severe adverse events occurred in the two group: 11.1% and 9.7% of patients in the PSE and non-PSE groups, respectively 1…”

“…Kim et al1 recently reported that partial splenic embolization (PSE) had good safety and efficacy to increase platelet counts in hepatocellular carcinoma (HCC) patients with thrombocytopenia who underwent trans-arterial chemoembolization (TACE). In this study, 18 HCC patients with severe thrombocytopenia (< 50 × 10 9 /L) who underwent PSE concurrently with TACE (PSE group) and 72 controls who underwent TACE alone (non-PSE group) were enrolled.…”

Sorafenib plus partial splenic embolism for treatment of hepatocellular carcinoma Barcelona stage C combined with hypersplenism: a case series

“…showed that PSE combined with TACE effectively induced and maintained improvements in thrombocytopenia and reduced the need for platelet transfusion. 8 PSE has been reported to be effective not only for improving cytopenia, but also for enhancing hepatic functional reserve and hepatic protein synthesis by decreasing splenic blood flow and increasing hepatic artery and superior mesentery artery blood flow. 9,10 Moreover, PSE can induce activation of host immunity 11 and promote anti-tumor effects.…”