By Yuqing Wang

From November 10 to 14, 2023, the 74th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2023) was held in Boston, USA. The CHANCE-CHESS series research results, led by Academician Gaojun Teng, President of the Interventional Physicians Branch of the Chinese Medical Association, Director of the Affiliated Zhongda Hospital of Southeast University, and founder of CHANCE, as well as Professor Xiaolong Qi, Assistant Director of the Affiliated Zhongda Hospital of Southeast University and head of CHESS, were orally presented at the conference.

Speaker: Wang Yuqing

Primary liver cancer ranks third in global malignant tumor mortality, with hepatocellular carcinoma (HCC) accounting for 75% to 85% (Sung H, et al. CA Cancer J Clin 2021). Transarterial chemoembolization (TACE) is currently the most commonly used non-surgical treatment for HCC and is recognized for its effectiveness (Park J W, et al. Liver Int 2015). According to the BCLC staging recommendations, TACE is recommended as the preferred treatment for B-stage HCC. It is also widely used in patients with BCLC stage C HCC (Reig M, et al. J Hepatol 2022; Zhou J, et al. Liver Cancer 2020).

Portal hypertension in liver cirrhosis is an important factor affecting the clinical prognosis of HCC patients (de Franchis R, et al. J Hepatol 2022). The severity of portal hypertension determines the occurrence and development of complications in cirrhosis, such as esophagogastric variceal bleeding. The incidence of portal hypertension in HCC patients is relatively high, with approximately 35-52% of early-stage HCC patients having concurrent portal hypertension (Thabut D, et al. J Hepatol 2022). At the same time, TACE itself has a certain impact on portal hypertension and liver function. Iodized oil deposition into the portal vein system causes portal vein occlusion, increasing resistance. Simultaneously, arterial embolization increases compensatory portal blood flow, further increasing portal vein pressure (Chinese Society of Surgery, Hepatic and Portal Vein Hypertension Surgery Group. Chin J Hepatol 2022).

The gold standard for the clinical diagnosis of clinically significant portal hypertension is a hepatic venous pressure gradient (HVPG) ≥10 mmHg (de Franchis R, et al. J Hepatol 2022). However, the clinical application of HVPG measurement is limited due to its invasive nature, cost, and popularization issues.

This study, a collaboration between the China Hepatocellular Carcinoma Interventional MDT Alliance CHANCE research platform and the Cirrhosis Portal Hypertension Alliance CHESS platform, is a retrospective analysis of HCC patients undergoing TACE. It applies a deep learning model based on CT-enhanced images to establish a diagnosis of portal hypertension and includes preliminary data from 261 patients from 11 centers. The results show that the median overall survival (OS) of patients with concurrent portal hypertension (16.9 months) is less than that of those without portal hypertension (20.7 months), and the difference is statistically significant (P=0.022). This suggests a significant correlation between portal hypertension and the clinical prognosis of HCC patients undergoing TACE, indicating that clinicians should consider the management of portal hypertension when treating HCC patients with TACE. Further precise evidence from clinical evidence-based medicine needs to be verified.

Reference:

[Wang Y, Jin ZC, Yu Q, et al. CT-based deep learning model of hepatic venous pressure gradient for predicting the prognosis of hepatocellular carcinoma with transarterial chemoembolization (CHANCE-CHESS): a multicenter cohort study. AASLD 2023. Oral 94.]