The incidence and predictors of post transarterial chemoembolization variceal bleeding in hepatocellular carcinoma patients

Po-Ting Lin; Wei Teng; Wen-Juei Jeng; Yi-Chung Hsieh; Chen-Fu Hung; Chien-Hao Huang; Kar-Wai Lui; Yi-Cheng Chen; Chen-Chun Lin; Shi-Ming Lin; I-Shyan Sheen; Chun-Yen Lin

doi:10.1016/j.jfma.2019.08.019

The incidence and predictors of post transarterial chemoembolization variceal bleeding in hepatocellular carcinoma patients

J Formos Med Assoc. 2020 Feb;119(2):635-643. doi: 10.1016/j.jfma.2019.08.019. Epub 2019 Sep 5.

Authors

Po-Ting Lin¹, Wei Teng², Wen-Juei Jeng³, Yi-Chung Hsieh⁴, Chen-Fu Hung⁵, Chien-Hao Huang⁶, Kar-Wai Lui⁷, Yi-Cheng Chen⁸, Chen-Chun Lin⁹, Shi-Ming Lin¹⁰, I-Shyan Sheen¹¹, Chun-Yen Lin¹²

Affiliations

¹ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan. Electronic address: [email protected].
² Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan. Electronic address: [email protected].
³ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan. Electronic address: [email protected].
⁴ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan. Electronic address: [email protected].
⁵ Department of Radiology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan. Electronic address: [email protected].
⁶ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan. Electronic address: [email protected].
⁷ Department of Radiology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan. Electronic address: [email protected].
⁸ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan. Electronic address: [email protected].
⁹ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan. Electronic address: [email protected].
¹⁰ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan. Electronic address: [email protected].
¹¹ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan. Electronic address: [email protected].
¹² Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan. Electronic address: [email protected].

PMID: 31495543
DOI: 10.1016/j.jfma.2019.08.019

Abstract

Background & aims: Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC) patients. Variceal bleeding is a life-threatening complication and may alter the initial treatment plan. This study was aimed to elucidate the risk factors for variceal bleeding in HCC patients receiving TACE treatment.

Methods: From 2005 to 2016, a total of 1233 treatment-naive HCC patients receiving first time TACE treatment in Chang Gung Memorial Hospital, Linkou medical center were recruited. Pre-TACE status including baseline characteristics, prior history of ascites, and parameters for liver function evaluation were analyzed. All the variables were compared between patients with and without variceal bleeding.

Results: Among the 1233 patients, the median age was 63.7 (range 25.8-91.5) years old, and 73.5% were male. Variceal bleeding events were documented in 19 patients (1.5%) within 3 months post TACE treatment. Patients with younger age, cirrhosis, pre-treatment ascites and advanced fibrosis status (higher MELD score, CTP score, ALBI grade, FIB-4 and APRI score) were more likely to encounter post-treatment variceal bleeding. Multivariate Cox regression analysis revealed existence of ascites (adjusted HR: 4.859 (1.947-12.124), p = 0.001), and higher FIB-4 score (adjusted HR: 4.481 (1.796-11.179), p = 0.001) were the independent predictive factors for variceal bleeding. Patients with post-TACE variceal bleeding are more likely to encounter tumor progression (42.1% vs. 20.3%, p = 0.039) and mortality owing to GI bleeding (15.8% vs. 3%, p = 0.032).

Conclusion: The incidence of post-TACE variceal bleeding was 1.5%. Patients with post-TACE variceal bleeding have poorer TACE treatment response. The pre-treatment ascites and FIB-4 score are the independent predictors for post-TACE variceal bleeding.

Keywords: Ascites; Gastrointestinal bleeding; Mortality; Portal hypertension; Treatment response.

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular / mortality
Carcinoma, Hepatocellular / therapy*
Chemoembolization, Therapeutic / adverse effects*
Esophageal and Gastric Varices / etiology*
Female
Gastrointestinal Hemorrhage / etiology*
Gastrointestinal Hemorrhage / mortality
Humans
Incidence
Liver Cirrhosis / complications
Liver Neoplasms / mortality
Liver Neoplasms / therapy*
Male
Middle Aged
Multivariate Analysis
Risk Factors
Survival Analysis
Taiwan / epidemiology
Treatment Outcome