Arterioportal shunts in patients with hepatocellular carcinoma treated using ethanol-soaked gelatin sponge: therapeutic effects and prognostic factors.

ABSTRACT

PURPOSE: To evaluate the efficacy and safety of transarterial embolization with ethanol-soaked gelatin sponge (ESG) for the treatment of arterioportal shunts (APSs) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: A total of 61 patients with unresectable HCC was included in this study, conducted from June 2008 to November 2011. These patients, who were treated with APSs, had received transarterial therapy. They underwent transarterial embolization of the shunt with ESG followed by transarterial chemoembolization if available. Changes in APSs, tumor response (per modified Response Evaluation Criteria in Solid Tumors), postembolization events, patient survival, and prognostic factors were analyzed. RESULTS: The median follow-up period was 13 months (range, 3-34 mo). The immediate APS improvement rate was 97% (59 of 61), and the APS improvement rate at first-time follow-up was 54% (33 of 61). Tumor response at 2 months after first embolization was as follows complete response in two patients (3.3%), partial response in 24 patients (39.3%), stable disease in 24 patients (39.3%), and progressive disease in 11 patients (18.1%). Survival rates were 79% at 6 months, 50% at 1 year, and 12% at 2 years; the median survival time was 382 days. Maximal tumor size and APS improvement at first-time follow-up were demonstrated to be independent prognostic factors (P < .05). CONCLUSIONS: Transarterial embolization with ESG may be safe and effective for the treatment of APSs in patients with unresectable HCC. Small maximal tumor size (< 5 cm) and an improvement in APSs favored overall survival.