Transarterial chemoembolization compared with conservative treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus: using a new classification

Abstract

We aimed to compare the survival benefit of transarterial chemoembolization (TACE) with conservative treatment for patients with advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT), furthermore, to reveal which PVTT types benefit from TACE treatment. From August 2007 to January 2010, a prospective controlled study was performed on consecutive patients with advanced HCC and PVTT. Of a total of 150 patients, 115 were treated with TACE (lipiodol and anticancer agents ± gelatin sponge embolization), and 35 who refused to accept the procedure were treated with conservative treatment. We performed survival analysis of the two treatment groups and then stratified by a new classification of PVTT that was divided into four types. Overall survival was significantly better in the TACE group than in the conservative group (8.67 months vs. 1.4 months, P<0.001). The overall median survival for types I-IV PVTT were 12.0, 8.3, 5.0, and 2.43 months (P<0.01). On subgroup analysis of PVTT, the median survival in the TACE group compared with conservative group for type I, II, III, and IV PVTT was 19.0 months versus 4.0 months, 11.0 months versus 1.43 months, 7.1 months versus 1.3 months, and 4.0 months versus 1.0 months, respectively (P<0.01). The TACE group had significantly better survival than the conservative group for different extent of PVTT. TACE is an effective treatment mode compared with conservative treatment for HCC and PVTT and may provide a significantly better survival benefit for different extent of PVTT.

Multidisciplinary management of hepatocellular carcinoma with portal vein tumor thrombus - Eastern Hepatobiliary Surgical Hospital consensus statement

“…This retrospective study revealed significant differences for PVTT patients with 1- and 3-year survival rates for type I, II, III, and IV being 52.1%, 38.2%, 24.7%, and 18.3% and 25.1%, 17.7%, 3.6%, and 0%, respectively ( P < 0.05). This Cheng's Classification is also suitable for HCC patients with PVTT undergoing TACE treatment and reported median survival time of 19.0 months, 11.0 months, 7.1 months, and 4.0 months for type I, II, III, and IV, respectively ( P < 0.05) [44]. To sum up, the Cheng's Classification better stratified and predicted prognosis than the TNM staging, CLIP scoring system, and JIS scoring system, providing better stratification for evaluating HCC patients.…”

Portal vein tumor thrombus is a bottleneck in the treatment of hepatocellular carcinoma

“…Referring to the results of a cohort study we published in 2007 25 , PVTT can be classified into four grades according to the extent of PVTT in the portal vein: type I, wherein a tumor thrombus is present in the segmental branches of the portal vein or above; type II, wherein the tumor thrombus is present in the right or left portal vein; type III, wherein the tumor thrombus is present in the main portal vein trunk; and type IV, wherein the tumor thrombus extends from the portal vein to the superior mesenteric vein. This classification system effectively predicts the long-term survival of patients after surgery 26 or TACE 27 . Therefore, this classification is useful for clinical decision-making processes in HCC treatment.…”

“…Nevertheless, evidence indicates that TACE can be performed safely and feasibly in select patients with good liver function and adequate collateral circulation around the occluded portal vein regardless of PVTT extent 27 . Since 2010, the 30-day mortality has been reported 37 to be < 1.2%.…”

Hong Kong Consensus Statements for the Management of Unresectable Hepatocellular Carcinoma

“…However, a prospective controlled study found that the survival benefit of TACE is minimal for patients with major PVT, with a greater benefit evident for patients with segmental PVT [43]. 25.…”