[Clinical effect of polyvinyl alcohol particles combined with chemoembolization in treatment of hepatocellular carcinoma complicated by hepatic arteriovenous shunt and related and prognostic factors].

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.

The effect of sequential transcatheter arterial chemoembolization (TACE) and portal venous embolizations (PVE) vs. TACE or PVE alone on rabbit VX2 liver carcinoma and on liver regeneration.

OBJECTIVE: This study aimed to build VX2 liver tumor model in rabbits and to investigate the sequential transcatheter arterial chemoembolization (TACE) and portal vein embolizations (PVE) vs. TACE or PVE alone on rabbit VX2 liver carcinoma and liver regeneration. MATERIALS AND METHODS: VX2 liver tumor models were built in the rabbit. Rabbits carrying VX2 liver tumors were divided into four groups, including TACE+PVE, TACE, PVE and Sham groups respectively. Hematoxylin and eosin (HE) staining was performed to visualize the structures of tumor tissues. The volume data of caudal liver on day 3 and day 7 was measured by CT. Western blot analysis of active caspase-3 was performed to examine cell apoptosis. Immunohistochemical (IHC) staining of Ki-67 was performed to visualize hepatocyte regeneration. Serum IL-6, TNF-alpha, HGF and TGF-beta1 on 6th h, 24th h, day 3 and day 7 were measured by ELISA assay. RESULTS: The TACE+PVE group had the strongest suppressive effect on tumor growth and induced the highest level of tumor cell apoptosis. TACE+PVE can induce evident liver regeneration, which is reflected by the largest caudal liver volume increase and the highest ratio of Ki-67 positive cells. ELISA assay showed that during the first 7 days since day 0, TACE+PVE group had the highest level of HGF, IL-6 and TNF-alpha. CONCLUSIONS: TACE+PVE can significantly inhibit VX2 tumor growth, induce tumor cell apoptosis and liver regeneration, the effects of which are stronger than TACE or PVE alone. In the first 7 days since day 0, TACE+PVE group had the highest level of IL-6, TNF-alpha and HGF. This might be the reason why TACE+PVE induced the strongest liver regeneration.