Background Transarterial radioembolization (TARE) is increasingly used in patients with hepatocellular carcinoma (HCC). This treatment can induce or impair portal hypertension, leading to hepatic decompensation. TARE also promotes changes in liver and spleen volumes that may modify therapeutic decisions and outcomes after therapy. Objectives We aimed to investigate the impact of TARE on the incidence of decompensation events and its predictive factors. Design In all, 63 consecutive patients treated with TARE between February 2012 and December 2018 were retrospectively included. Methods We assessed clinical (including Barcelona Clinic Liver Cancer stage, portal hypertension assessment, and liver decompensation), laboratory parameters, and liver and spleen volumes before and 6 and 12 weeks after treatment. A multivariate analysis was performed. Results In total, 18 out of 63 (28.6%) patients had liver decompensation (ascites, variceal bleeding, jaundice, or encephalopathy) within the first 3 months after therapy, not associated with tumor progression. Clinically significant portal hypertension (CSPH) and bilobar treatment independently predicted the development of liver decompensation after TARE. A significant volume increase in the non-treated hemi-liver was observed only in patients with unilobar treatment (median volume increase of 20.2% in patients with right lobe TARE; p = 0.007), especially in those without CSPH. Spleen volume also increased after TARE (median volume increase of 16.1%; p = 0.0001) and was associated with worsening liver function scores and decreased platelet count. Conclusion Bilobar TARE and CSPH may be associated with an increased risk of liver decompensation in patients with intermediate or advanced HCC. A careful assessment considering these variables before therapy may optimize candidate selection and improve treatment planning.

中文翻译：

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门静脉高压增加肝细胞癌患者 90 钇放射栓塞后肝功能失代偿的风险：一项队列研究。

背景 经动脉放射栓塞（TARE）越来越多地用于肝细胞癌（HCC）患者。这种治疗可诱发或损害门静脉高压，导致肝功能失代偿。TARE 还促进肝脏和脾脏体积的变化，这可能会改变治疗决策和治疗后的结果。目的 我们旨在调查 TARE 对失代偿事件发生率的影响及其预测因素。设计 总共回顾性纳入了 2012 年 2 月至 2018 年 12 月期间接受 TARE 治疗的 63 名连续患者。方法 我们在治疗前以及治疗后 6 周和 12 周评估了临床（包括巴塞罗那临床肝癌分期、门静脉高压评估和肝脏代偿失调）、实验室参数以及肝脏和脾脏体积。进行了多变量分析。结果 63 名患者中有 18 名（28.6%）在治疗后前 3 个月内出现肝脏失代偿（腹水、静脉曲张出血、黄疸或脑病），与肿瘤进展无关。具有临床意义的门脉高压 (CSPH) 和双叶治疗可独立预测 TARE 后肝脏失代偿的发生。仅在接受单叶治疗的患者中观察到未经治疗的半肝体积显着增加（右叶 TARE 患者中位体积增加 20.2%；p = 0.007），特别是在没有 CSPH 的患者中。TARE 后脾体积也增加（中位体积增加 16.1%；p = 0.0001），并且与肝功能评分恶化和血小板计数减少相关。结论 双叶 TARE 和 CSPH 可能与中晚期 HCC 患者肝脏失代偿风险增加相关。在治疗前考虑这些变量的仔细评估可能会优化候选者的选择并改善治疗计划。