Effects of Location and Extension of Portal Vein Tumor Thrombus on Long-Term Outcomes of Surgical Treatment for Hepatocellular Carcinoma

Chen, Xiaoping; Qiu, Fa-Zu; Wu, Zai-De; Zhang, Zhiwei; Huang, Zhiyong; Chen, Yifa; Zhang, Bixiang; He, Songqing; Zhang, Wanguang

doi:10.1245/aso.2006.08.007

Cited by 126 publications

(124 citation statements)

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“…In our study, after HR, there was one postoperative in-hospital death caused by postoperative liver failure (0.5%), and the major complication rate was 4.0% (8 of 201), our results were similar to the studies reported previously. [13][14][15][16][17][18][19][20][21][22] Therefore, HR is still a safe treatment for HCC with PVTT.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12] To improve on the results of treatment of HCC with PVTT, attempts have been made to perform HR for these patients. [13][14][15][16][17][18][19][20][21][22] HCC with PVTT remains a contraindication to liver transplantation because of the high rate of tumor recurrence, and because of the severe shortage of donor organs. HR remains the only therapeutic option that may still offer a chance of cure.…”

Section: Introductionmentioning

confidence: 99%

“…More HCC with PVTT, which previously were considered as unresectable, have become resectable. [13][14][15][16][17][18][19][20][21][22] Recent studies have even shown favorable long-term survival outcomes of HR in well-selected cases of HCC with PVTT. 21,22 However, the survival outcomes of patients with HCC with PVTT treated with HR or with TACE have not been properly compared.…”

Section: Introductionmentioning

confidence: 99%

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Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus

Peng

Guo

Zhang

et al. 2012

Cancer

144

163

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BACKGROUND:The long‐term survival outcomes of hepatic resection (HR) compared with transcatheter arterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) are unclear.MATERIALS AND METHODS:Between December 2002 and December 2007, 201 consecutive patients diagnosed with resectable HCC with PVTT received HR as an initial treatment in our center. These patients were compared with 402 case‐matched controls selected from a pool of 1798 patients (with a 1:2 ratio) who received TACE as an initial treatment during the study period. PVTT was classified to 4 types: PVTT involving the segmental branches of the portal vein or above (type I), PVTT extending to involve the right/left portal vein (type II), the main portal vein (type III), or the superior mesenteric vein (type IV).RESULTS:The 1‐, 3‐, and 5‐year overall survivals for the HR and TACE groups were 42.0%, 14.1%, and 11.1% and 37.8%, 7.3%, and 0.5%, respectively (P < .001). On subgroup analyses, the overall survivals for the HR group were better than the TACE group for type I PVTT, type II PVTT, single tumor, and tumor size >5 cm (P < .001, P = .002, P < .001, P < .001, respectively), but not for type III PVTT, type IV PVTT, multiple tumors, and tumor size <5 cm (P = .541, P = .371, P = .264, P = .338, P = .125, respectively). Multivariate analysis showed the type of PVTT and initial treatment allocation were significant prognostic factors for overall survival.CONCLUSIONS:Compared with TACE, HR provided survival benefits for patients with resectable HCC with PVTT, especially for those with a type I PVTT or a type II PVTT. Cancer 2012. © 2012 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus

Peng

Guo

Zhang

et al. 2012

Cancer

144

163

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“…HCC has become the fifth most prevalent malignancy worldwide and the third leading cause of cancer-related death, most importantly, the incidence of HCC is increasing [1,2] , and 82% of cases are in developing countries, with 55% in China alone [3] . Invasion and metastasis are two fundamental properties, which determine the prognosis of the HCC patients [4,5] . Many signaling pathways are thought to be involved in the development and invasion of HCC, including the MAPK pathway [6,7] , phosphatidylinositol-3 kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) pathway [8][9][10] , the wnt/beta-catenin pathway [9,11] , hepatocyte growth factor/c-MET pathway [12,13] , hedgehog (Hh) signaling pathway, and so on.…”

Section: Introductionmentioning

confidence: 99%

Hedgehog signaling pathway mediates invasion and metastasis of hepatocellular carcinoma via ERK pathway

Lü

Zhao

et al. 2012

Acta Pharmacol Sin

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Aim: To investigate the role of Hedgehog (Hh) signaling pathway in the invasion and metastasis of human hepatocellular carcinoma (HCC). Methods: Eighty six HCC tissues samples and HCC cell line Bel-7402 were examined. The protein expression of sonic hedgehog (Shh), nuclear glioma-associated oncogene-1 (Gli1), MMP-9 and p-ERK1/2 in HCC was analyzed using immunohistochemistry and Western blot analysis. Boyden chamber assay and wound-healing assay were used to quantify the invasion and metastasis of Bel-7402 cells. Results: In 86 HCC tissue samples, the positive ratio of Shh and nucleus Gli1 was 67.44% (58/86) and 60.47% (52/86), respectively; the expression of nucleus Gli1 was correlated with the tumor pathological grade (P=0.034), and with the ability of the tumor to invade and metastasize (P=0.001); the expression of nucleus Gli1 was also correlated with p-ERK1/2 (P=0.031) and with MMP-9 (P=0.034). Neither Shh, nor nucleus Gli1 was observed in normal liver tissue. KAAD-cyclopamine (KAAD-cyc), a specific inhibitor of the Hh pathway, at the concentrations of 1 and 4 μmol/L inhibited the invasion and migration of Bel-7402 cells and decreased the expression of Gli1 in nucleus and MMP-9, p-ERK1/2 proteins in Bel-7402 cells. On the other hand, Shh, a ligand of the Hh pathway, at the concentration of 0.5 μg/mL produced opposite effects. The MAPK pathway inhibitors U0126 and PD98059 at the concentrations of 5 and 10 μmol/L inhibited invasion and metastasis of Bel-7402 cells induced by Shh, and decreased the expression of p-ERK1/2 and MMP-9. However, U0126 and PD98059 had no effect on the expression of Gli1. Conclusion: Hh signaling pathway mediates invasion and metastasis of human HCC by up-regulating the protein expression of MMP-9 via ERK pathway.

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“…Chen and colleagues [14] surgically treated 438 patients with HCC and PV invasion: 286 of them had PVTT not extended into the MPV and were treated with hepatic resection only, while 152 patients had PVTT extended into the PV and were treated with hepatic resection and thrombectomy. Six months recurrence rates were 11.3% in the first group and 76.9% in the second group.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation of hepatocellular carcinoma extended into the portal vein: Preliminary results

Giorgio

Stefano

Sarno

et al. 2009

Journal of Ultrasound

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Introduction: We report our preliminary results of radiofrequency (RF) ablation of hepatocellular carcinoma (HCC) and neoplastic portal thrombus (NPT) in cirrhotic patients. Methods: Ten patients (7 males and 3 females; mean age 68 yrs) with 10 HCC nodules (37e49 mm) extended into the main portal vein (MPV) underwent RF ablation. Diagnosis of NPT was achieved by fine-needle biopsy. RF ablation was performed firstly on the NPT and then on the HCC. RF ablation was considered successful when complete necrosis of the HCC and complete recanalization of the MPV were achieved. HCC necrosis was evaluated using contrast-enhanced CT. Recanalization of the portal vessels (PV) was analyzed using Color Doppler (CD). RF ablation was performed under ultrasonographic (US) guidance using a perfused electrode needle. Results: Complete necrosis of the HCC with complete recanalization of the PV was observed in 7 patients (success rate: 70%). In the remaining 3, necrosis of the HCC ranged from 70% to 95%, and recanalization of the PV was not complete. No major complications occurred. In 2 cases, mild ascites and increased aspartate aminotransferase/alanine aminotransferase (AST/ALT) values were observed. The follow-up ranged from 4 to 24 months; 1 and 2-year survival rates were 77% and 77%, respectively. At the last follow-up, the 7 successful patients were alive and the portal system was still patent. The 3 unsuccessful patients died within 5 months due to progressive disease. Conclusion: RF ablation can destroy HCC and NPT achieving a high rate of efficacy and low rate of complications. However, to confirm these results a control group and a longer follow-up are required.Sommario Scopo: In questo studio riportiamo i dati relativi all'ablazione percutanea con Radiofrequenza (RF) di HCC e trombosi neoplastica dei vasi portali. Pazienti e metodi: Dieci pazienti (pz) cirrotici, 7 maschi e 3 femmine, età media 68 anni, con 10 noduli di HCC e trombosi neoplastica dei vasi portali sono stati sottoposti ad ablazione percutanea con RF del trombo neoplastico e dell'HCC. La RF veniva ritenuta efficace quando alla TC con mdc si osservava la necrosi completa dell'HCC e al Color Doppler si osservava la ricanalizzazione completa dei vasi portali. Risultati: La necrosi completa dell'HCC e la ricanalizzazione completa dei vasi portali si osservava in 7 (70%) dei 10 pazienti. Nei rimanenti 3 (30%) la necrosi dell'HCC e la ricanalizzazione dei vasi portali non risultavano complete. Non si osservavano complicanze maggiori. Tutti i pazienti venivano dimessi il giorno dopo la procedura. Follow-up 4e24 mesi. Le percentuali di sopravvivenza sono dell'80% ad 1 anno e del 70% a 2 anni. I 3 pazienti nei quali la procedura non è stata completamente efficace sono deceduti entro 5 mesi dalla procedura per progressione della patologia neoplastica. Nei 7 pazienti nei quali la procedura è stata efficace il sistema portale è a tutt'oggi completamente ricanalizzato. Conclusioni: Questi primi risultati evidenziano che la RF è in grado di determinare necrosi...

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Effects of Location and Extension of Portal Vein Tumor Thrombus on Long-Term Outcomes of Surgical Treatment for Hepatocellular Carcinoma

Abstract: Liver resection with thrombectomy yielded better outcomes in the HCC patients with PVTT confined to the first or second branch of the main portal vein compared with PVTT extending into the main portal vein.

Cited by 126 publications

References 24 publications

Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus

Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus

Hedgehog signaling pathway mediates invasion and metastasis of hepatocellular carcinoma via ERK pathway

Radiofrequency ablation of hepatocellular carcinoma extended into the portal vein: Preliminary results

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