Effect of Partial Splenic Embolization on Immune Environment and Hepatic Function in Cirrhosis Patients With Portal...

In hepatocellular carcinoma (HCC), portal hypertension (PHT) during the advanced stages of cirrhosis leads to splenomegaly. Additionally, the immune environment is an important factor in HCC treatment. Splenectomy and partial splenic embolization (PSE) are expected to improve this condition; however, data on the effects of PSE on immune function are limited. Therefore, we investigated the effects of PSE on the immune environment and hepatic function in patients with PHT-related cirrhosis.

The study included 117 of 238 patients who underwent PSE for PHT at our Department between 2011 and 2024 and were followed-up for more than 12 months, excluding those who underwent additional procedures concurrent with PSE. Changes in blood cell counts, hepatic function and immunological parameters including the neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio, were examined.

The mean splenic volume, mean splenic infarction volume, and splenic infarction rate were 396.64 ml, 222.8 ml, and 58.6%, respectively. The preoperative splenic volume was inversely correlated with platelet and lymphocyte counts. The platelet count increased from 7.3 to 10.4 at 1 year; the platelet-albumin-bilirubin score improved from -2.38 to -2.49 (p<0.01); the fibrosis-4 index improved from 6.02 to 4.69 (p<0.01); the albumin-bilirubin score improved from -2.10 to -2.27 (p<0.01); and the NLR improved from 2.49 to 2.25 (p=0.028). Additionally, analysis of the background liver revealed improvements in platelet count and NLR.

PSE not only improved platelet counts, but also increased lymphocyte counts and improved the NLR. PSE-induced improvements in the immune environment may be useful for introducing combination immunotherapy for HCC.