Predictors of treatment response following aspiration sclerotherapy of hepatic cysts: an international pooled analysis of individual patient data
Predictors of treatment response following aspiration sclerotherapy of hepatic cysts: an international pooled analysis of individual patient data
Titus F. M. Wijnands 0 1 2
Maxime Ronot 0 1 2
Tom J. G. Gevers 0 1 2
Julie Benzimra 0 1 2
Leo J. Schultze Kool 0 1 2
Valérie Vilgrain 0 1 2
Joost P. H. Drenth 0 1 2
0 Department of Radiology, Radboud University Medical Center , Nijmegen , The Netherlands
1 Department of Radiology, Beaujon University Hospitals Paris Nord Val de Seine , Clichy , France
2 Department of Gastroenterology and Hepatology, Radboud University Medical Center , P.O. Box 9101, code 455, 6500 HB Nijmegen , The Netherlands
3 Joost P. H. Drenth
Objectives To identify predictive variables of treatment response following aspiration sclerotherapy of large symptomatic hepatic cysts. Methods We collected individual patient data from two tertiary referral centres and included all patients treated with aspiration sclerotherapy of a large (>5 cm), symptomatic hepatic cyst. At six months, clinical response was defined as complete or incomplete. Secondary, suboptimal technical response was defined as lower quartile of cyst reduction. Predictive variables of clinical and technical response were analyzed by logistic regression analysis. Results We included 86 patients (58 ± 10 years; female 90 %). Complete clinical response rate was 55 %. Median cyst diameter and volume reduction were 71 % (IQR 50-87 %) and 98 % (IRQ 88-100 %), respectively. Patients with complete clinical response had a significantly higher cyst reduction compared to incomplete responders (OR 1.02, 95 % CI 1.00-1.04). Aspiration of haemorrhagic cyst fluid (OR 4.39, 95 % CI 1.34-14.39) or a lower cyst reduction at one month (OR 1.06, 95 % CI 1.02-1.10) was associated with a suboptimal technical response at six months. Conclusion Complete clinical response is associated with effective cyst reduction. Aspiration of haemorrhagic cyst fluid or a restricted diameter reduction at one month predicts a suboptimal technical treatment response, however, these variables did not predict symptom disappearance. Key Points Aspiration sclerotherapy of hepatic cysts shows excellent clinical and technical efficacy. Optimal clinical responders have a markedly higher cyst reduction. Haemorrhagic aspirate and a strong fluid reaccumulation predict suboptimal cyst reduction.
Hepatic cyst; Polycystic liver disease; Interventional; Drainage; Sclerotherapy
Introduction
Hepatic cysts are fluid-filled cavities that arise from congenital
malformations of biliary ducts [
1
]. The estimated prevalence
of these benign, non-parasitic lesions is 2-18 % in the general
population [
2–4
]. Hepatic cysts occur solitary or as multiple
lesions in the context of polycystic liver disease (PLD) [
5
].
Aspiration sclerotherapy is a minimally invasive treatment
option and serves as first-choice treatment for symptomatic
hepatic cysts [
6–8
]. Aspiration sclerotherapy combines
percutaneous drainage of cyst fluid with subsequent instillation of a
sclerosing agent that destroys the inner cyst lining. This
treatment is effective and safe [
9–14
]. There are two components
that are important to the perceived success of aspiration
sclerotherapy treatment. First, clinical response as
experienced by the patient, and second, technical response in terms
of reduction of the treated cyst. It is not well understood which
factors determine clinical success or are important for
technical response. Due to the infrequency of large symptomatic
hepatic cysts, published studies are relatively small, which is
an obstacle on the road to identification of predictive factors.
In this study, we collected individual patient data from two
observational cohort studies with comparable treatment
protocols and follow-up measurements. The goal of this study
was to identify variables that predict response of aspiration
sclerotherapy of large symptomatic hepatic cysts.
Materials and methods
Patients and study design
We performed a pooled analysis of data collected from
patients that consecutively underwent aspiration sclerotherapy
in two tertiary referral centres: Radboud University Medical
Center, Nijmegen, the Netherlands (centre 1) and University
Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
(centre 2) (Table 1). Centre 1 prospectively included patients
treated within a timeframe of June 2012 to March 2014, centre
2 retrospectively included patients treated from December
2003 to September 2011. Within this timeframe the treatment
protocol remained unchanged. For this analysis we included a
cohort (centre 2) that was previously published to report
efficacy of aspiration sclerotherapy [
13
]. In the current study, we
extended our data by pooling this sample with a second
prospective cohort (centre 1). By this, we created a large sample
size that was needed to evaluate predictors of treatment
response.
Included patients were aged over 18 years and underwent
aspiration sclerotherapy o (...truncated)