The Effect of TACE on the Liver Function in Patients with Tumor Thrombus in the Portal Vein and the Therapeutic Evaluation of TACE

Objective To evaluate the effect of transcatheter arterial chemoembolization (TACE) treatment on the liver function in patients with hepatocellular carcinoma (HCC) accompanied with tumor thrombus in the portal vein and to evaluate the therapeutic effectiveness of TACE.Materials and Methods The results of TACE in 26 patients of HCC with portal vein thrombus, located in the portal trunk (n=7) or in the first level branch (n=19), were retrospectively analyzed. Before TACE, baseline liver function was evaluated with Child Pugh scores and other indicators. A total of 57 TACE, using lipiodol anticarcinogen emulsion only, was performed with the catheter tip being placed in lobar arteries. Liver function was re examined at 3 days, 1, 2 and 4 weeks after the procedure. The regression of the tumor and the survival time were recorded to evaluate the therapeutic effectiveness.Results The mean baseline Child Pugh score was 5.731±1.151. After the procedure, the Child Pugh score was increased in all patients to 6.692±1.369 at 3 days, 6.632±1.243 at one week, 6.482±1.491 at 2 weeks and 6.038±1.310 at 4 weeks (P0.001, 0.001, 0.01 and 0.05, respectively). The increase of Child Pugh scores was mainly due to the elevation of serum levels of total bilirubin (TBIL) in the early days after TACE, while in later period it was correlated with the decrease of albumin (ALB) and the development or exacerbation of ascites. Remarkable regression of the tumor was found in 8 patients, and the lesion was stable in size in 12 patients. The cumulative survival rate at 6, 12 and 24 months was 84.6%, 42.3% and 3.8%, respectively. Two patients died of acute hepatic failure.Conclusion TACE is an effective treatment for HCC with tumor thrombus in the portal vein with an increase of survival rate, although it may aggravate the impairment of the liver function, even causing acute hepatic failure. Therefore, superselective embolization of tumor feeding arteries should be advocated.