title: [Clinical effect of polyvinyl alcohol particles combined with chemoembolization in treatment of hepatocellular carcinoma complicated by hepatic arteriovenous shunt and related and prognostic factors].
abstract: Objective:To investigate the clinical effect of polyvinyl alcohol (PVA) particles combined with chemoembolization using chemotherapeutic agents or chemotherapeutic agents lipiodol emulsion (CALE) in the treatment of hepatocellular carcinoma (HCC) complicated by hepatic arteriovenous shunt (HAVS) and related prognostic factors.Methods:A retrospective analysis was performed for the clinical data of 133 patients with HCC complicated by HAVS. HAVS was classified into slow-flow HAVS, intermediate-flow HAVS, and high-flow HAVS, which were treated with 300-500μm, 500-710μm, and 710-1000μm PVA particles, respectively. The patients with slow-flow and intermediate-flow HAVS underwent embolization with PVA combined with chemotherapeutic agents followed by CALE, while those with high-flow HAVS underwent the treatment with PVA combined with chemotherapeutic agents alone. The survival time, progression-free survival time, and postoperative complications were followed up and analyzed. The Kaplan-Meier method was used to calculate cumulative survival rate and the Cox proportional hazards model was used to determine prognostic factors.Results:The median overall survival (OS) of 133 patients was 9.1 months, and the 6-, 12-, and 24-month survival rates were 73.7%, 36.2%, and 10.2%, respectively. The median OS of slow-flow group (36 patients), intermediate-flow group (58 patients), and high-flow group (39 patients) were 7.3, 9.1, and 10.8 months, respectively. And the 6- and 12-month survival rates were 69.2%/19.0%, 72.4%/39.2%, and 77.8%/42.7%, respectively. There was no significant difference in survival time between the patients with different types of HAVS (χ2= 2.865,P= 0.239). The incidence rates of postoperative gastroesophageal variceal bleeding and acute liver failure were 1.1% and 0.4%, respectively. The results of Cox regression analysis showed that preoperative alpha-fetoprotein level≥400 ng/ml (HR= 2.105,P= 0.006) was an independent risk factor, while multiple embolizations (HR= 0.482,P= 0.011), tumor remission (HR= 0.431,P= 0.041), and multimodality therapy (HR= 0.416,P= 0.004) were independent protective factors.Conclusion:PVA particles combined with chemotherapeutic agents or CALE is safe and effective in the treatment of HCC complicated by HAVS. Patients with multiple embolizations, tumor remission, and multimodality therapy tend to have good prognosis, while those with a high level of alpha-fetoprotein before embolization often have poor prognosis.
authors.affiliation: Department of Interventional Radiology, Affiliated Zhongshan Hospital, Xiamen University, Xiamen 361004, China(Liu QS); Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China(Mei QL, Li YH, He XF, Zeng QL, Pang HJ, Xiao LJ).
authors.forename: Q S
authors.initials: QS
authors.lastname: Liu
authors.forename: Q L
authors.initials: QL
authors.lastname: Mei
authors.forename: Y H
authors.initials: YH
authors.lastname: Li
authors.forename: X F
authors.initials: XF
authors.lastname: He
authors.forename: Q L
authors.initials: QL
authors.lastname: Zeng
authors.forename: H J
authors.initials: HJ
authors.lastname: Pang
authors.forename: L J
authors.initials: LJ
authors.lastname: Xiao
mesh_terms: D001164:Arteriovenous Fistula; D001166:Arteriovenous Shunt, Surgical; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000453:epidemiology; D004998:Ethiodized Oil; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011142:Polyvinyl Alcohol / Q000009:adverse effects*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D000509:alpha-Fetoproteins
chemical_list: D000509:alpha-Fetoproteins; D004998:Ethiodized Oil; D011142:Polyvinyl Alcohol