Liver resection versus transcatheter arterial chemoembolization for the treatment of patients with hepatocellular carcinoma and hepatic vein or inferior vena cava tumor thrombus: A propensity score matching analysis

Abstract

Aim: Because of the rarity of hepatic vein tumor thrombus (HVTT) in patients with hepatocellular carcinoma (HCC), little is known about HVTT. Thus, the survival benefit of liver resection (LR) versus transcatheter arterial chemoembolization (TACE) for HCC patients with HVTT or inferior vena cava tumor thrombus (IVCTT) remains controversial. We aimed to explore the survival benefits of LR versus TACE for the treatment of these patients.Methods: From 2012 to 2016, a total of 276 patients with HVTT or IVCTT who underwent liver resection or TACE were enrolled in this study. Patients in the LR group were matched at a 1:1 ratio with patients treated with TACE as an initial treatment (TACE group). Clinical characteristics, overall survival, and diseasefree survival were analyzed. Results:The median survival time in the LR group was 4.7 months longer than that in the TACE group before PSM (19.4 vs. 14.7 months, P = 0.006) and 6.9 months longer than that in the TACE group after PSM (20.9 vs. 14.0 months, P = 0.019). The median disease-free survival time in the LR group was 3.2 months longer than that in the TACE group before PSM (12.3 vs. 9.1 months, P = 0.038) and 5.8 months longer than that in the TACE group after PSM (13.0 vs. 7.2 months, P = 0.011). Conclusion:Liver resection provides a good prognosis for HCC patients with HVTT or IVCTT compared with patients undergoing TACE, and coexistence with portal vein tumor thrombus is the most important factor related to survival. Figure 1 Flowchart of screening hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (HVTT) or inferior vena cava tumor thrombus (IVCTT) undergoing hepatic resection (HR) or transcatheter chemoembolization (TACE).

Prognostic model for identifying candidates for hepatectomy among patients with hepatocellular carcinoma and hepatic vein invasion

“…Tumour burden is known to be a vital prognostic factor for HCC among all candidate predictors in many scoring systems, regardless of whether LR or non‐LR treatment is used. Coexisting PVTT is also a known risk factor for survival after LR. In the present study, the incidence of coexisting PVTT ranged from 41·9 to 52·4 per cent, which was lower than the incidence of 64·4–74·4 per cent in the Japanese national survey.…”

“…Macrovascular invasion, including PVTT and HVTT, is a known risk factor affecting long‐term survival in patients with HCC. The reported incidence of HVTT in patients with HCC ranges from 1·4 to 4·9 per cent. HVTT is less common than PVTT.…”

“…A Japanese nationwide survey from 2000 to 2007 reported that hepatic vein invasion was observed in only 4·5 per cent of the entire population. With advances in perioperative management and surgical techniques, LR has been performed successfully in selected patients with HCC and HVTT or PVTT in many centres. In a propensity score‐matched (PSM) cohort study, the median survival time of patients with HCC and HVTT was 2·89 years longer in the LR group than the non‐LR group before PSM, and 1·61 years longer after PSM.…”

“…The 1‐, 2‐ and 3‐year OS rates were 66·5, 37·4 and 28·5 per cent in the LR group compared with 32·3, 18·7 and 15·6 per cent in the TACE group ( P = 0·015). A recent study from EHBH showed LR to result in better prognosis than TACE for patients with HCC and HVTT and IVCTT. All these results are in agreement with the present findings that, in selected patients, LR resulted in better prognosis than non‐LR treatments ( P < 0·001 for OS).…”

“…A recent Japanese nationwide survey showed that liver resection (LR) was associated with improved prognosis in selected patients with HCC and HVTT or inferior vena cava tumour thrombus (IVCTT), especially in patients without PVTT. Other studies also showed that LR resulted in better prognosis than transcatheter arterial chemoembolization (TACE) in selected patients with HCC and HVTT or IVCTT. Recent advances in surgical techniques and perioperative management have made LR safe for patients with HCC and major vascular invasion, with low in‐hospital mortality rates of 2·8–3·3 per cent.…”