Efficacy and Safety of Transarterial Chemoembolization and Repeated Partial Splenic Embolization for Hepatocellular Carcinoma with Hypersplenism and Thrombocytopenia

Abstract

Aim

Partial splenic embolization (PSE) combined with transarterial chemoembolization (TACE) has been reported in treatment of hepatocellular carcinoma (HCC) with cirrhotic hypersplenism and thrombocytopenia. However, efficacy and safety of repeated PSE when required are unclear. This study aims to investigate post-procedural changes in peripheral blood cell and hepatic function, progression-free survival (PFS), and safety of HCC patients with hypersplenism received TACE and repeated PSE compared to those received TACE alone.

Methods

This retrospective study included 102 HCC patients with hypersplenism who received TACE (n = 73) or TACE+PSE (n = 29) from January 2014 to December 2021. Changes in peripheral blood cell and hepatic function were investigated at 1 week, 2, 6, 12, 18, and 24 months. TACE procedure sessions and adverse events were recorded. PFS and prognostic factors were analyzed.

Results

Despite response to initial PSE being limited, repeated PSE increased platelet (PLT) again, which peaked at 18 months. It also continued to improve red blood cell (RBC) and hemoglobin, which showed significant differences in changes from baseline between two groups until 24 months, as well as Child-Pugh scores at 12 and 18 months. Mean TACE procedure sessions were significantly higher in TACE+PSE group than that in TACE alone group (4.55 vs 3.26, P = 0.019). TACE+PSE group had longer median PFS (19.4 vs 9.5 months, P = 0.023) than TACE alone group, where PSE was an independent protective factor (HR, 0.508; P = 0.014). Initial and repeated PSE showed no significant differences in safety.

Conclusion

Repeated PSE is effective in increasing PLT again and improving RBC, hemoglobin and liver function. It contributed to performing serial TACE procedures thereafter. TACE combined with repeated PSE has significantly longer PFS than TACE alone, where PSE was an independent protective factor. Moreover, the safety of repeated PSE was comparable to initial PSE.

Keywords:

• hepatocellular carcinoma
• hypersplenism
• transarterial chemoembolization
• partial splenic embolization

Abbreviations

HCC, hepatocellular carcinoma; PSE, partial splenic embolization; PLT, platelet; TACE, transarterial chemoembolization; PFS, progression-free survival; BCLC, Barcelona Clinic Liver Cancer; TACE+PSE, transarterial chemoembolization combined with concurrent partial splenic embolization; C-TACE, conventional transarterial chemoembolization; DEB-TACE, drug-eluting bead transarterial chemoembolization; ALT, alanine aminotransferase; AST, aspartate aminotransferase; WBC, white blood cell; RBC, red blood cell; HBV, hepatitis B virus; HCV, hepatitis C virus; NBNC, non-B, non-C hepatitis; HR, hazard ratio; CI, confidence interval.

Data Sharing Statement

The data are available from the corresponding author upon reasonable request.

Ethical Statements

This study was approved by the ethics committee of Tongji Medical College, Huazhong University of Science and Technology, and the requirement for informed consent was waived due to its retrospective nature. The study was performed according to the principles of the Declaration of Helsinki and the confidentiality of patient data was ensured.

Acknowledgment

We would like to express our gratitude to Ziwei Zhu from Department of Epidemiology and Biostatistics, Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China for assistance in statistical analysis.

Disclosure

The authors disclose no conflicts of interest in this work.

Additional information

Funding

There is no funding to report.