Survival outcomes of hepatic resection compared with transarterial chemoembolization or sorafenib for hepatocellular carcinoma with portal vein tumor thrombosis

Abstract

Background/Aims:Treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains controversial. We compared the outcomes of hepatic resection (HR), transarterial chemoembolization (TACE), and sorafenib therapy as treatments for HCC with PVTT.Methods:Patients diagnosed as HCC with PVTT between January 2000 and December 2011 who received treatment with sorafenib, HR, or TACE were included. Patients with main PVTT, superior mesenteric vein tumor thrombosis, or Child-Turcotte-Pugh (CTP) class C were excluded. The records of 172 patients were analyzed retrospectively. HR, TACE, and sorafenib treatment were performed is 40, 80, and 52 patients respectively. PVTT was classified as either involving the segmental branch (type I) or extending to involve the right or left portal vein (type II).Results:The median survival time was significantly longer in the HR group (19.9 months) than in the TACE and sorafenib groups (6.6 and 6.2 months, respectively; both p<0.001), and did not differ significantly between the latter two groups (p=0.698). Among patients with CTP class A, type I PVTT or unilobar-involved HCC, the median survival time was longer in the HR group than in the TACE and sorafenib groups (p=0.006). In univariate analyses, the initial treatment method, tumor size, PVTT type, involved lobe, CTP class, and presence of cirrhosis or ascites were correlated with overall survival. The significant prognostic factors for overall survival in Cox proportional-hazards regression analysis were initial treatment method (HR vs. TACE: hazard ratio=1.750, p=0.036; HR vs. sorafenib: hazard ratio=2.262, p=0.006), involved lobe (hazard ratio=1.705, p=0.008), PVTT type (hazard ratio=1.617, p=0.013), and CTP class (hazard ratio=1.712, p=0.012).Conclusions:Compared with TACE or sorafenib, HR may prolong the survival of patients with HCC in cases of CTP class A, type I PVTT or unilobar-involved HCC.

Hepatic resection compared to chemoembolization in intermediate‐ to advanced‐stage hepatocellular carcinoma: A meta‐analysis of high‐quality studies

“…The details and reasons for exclusion requiring consensus between the authors are described in http://onlinelibrary.wiley.com/doi/10.1002/hep.29883/suppinfo. Finally, 18 studies reporting PH versus TACE in BCLC stage B or stage C patients were included in the systematic review and meta‐analysis.…”

“…Eighteen trials (one RCT, five PSM NRCTs, and 12 NRCTs) consisting of 20 data sets and a total of 5,986 patients were included in the meta‐analysis. The RCT was a single‐center trial conducted in China .…”

Complete response with sorafenib and transcatheter arterial chemoembolization in unresectable hepatocellular carcinoma

“…A median OS period after treatment with TACE was reported to be 5.6-16.5 mo in patients with HCC accompanied by PVTT[11-13]. A median OS period after treatment with surgery was reported to be 6-19.9 mo[14-16]. Furthermore, Minagawa et al[16] reported a high survival rate in these patients with the combination of TACE followed by hepatic resection.…”

Treatment of high-burden hepatocellular carcinoma: an oncologist perspective

“…Surgery has been considered contraindicated by many institutions, including the BCLC system [41] . However, many studies, particularly those from the Asian centers, have reported hepatic resection to be safe and effective for patients with portal vein invasion [28,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] [ Table 3]. The median 1-, 3-and 5-year overall survival rates for patients with all forms of portal vein invasion treated with surgery were 61.0%, 32.9% and 27.0% respectively.…”

“…[48] Vp1 Lee et al . [47] Vp1 In view of this, much effort has been made to devise new intra-arterial therapies with less systemic toxicities. In recent years, TARE has become an alternative to TACE in treating high-burden HCC.…”