Clin Mol Hepatol.  2016 Mar;22(1):160-167. 10.3350/cmh.2016.22.1.160.

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

• Lee JM
• Jang BK
• Lee YJ
• Choi WY
• Choi SM
• Chung WJ
• Hwang JS
• Kang KJ
• Kim YH
• Chauhan AK
• Park SY
• Tak WY
• Kweon YO
• Kim BS
• Lee CH

• KMID: 2363034
• DOI: http://doi.org/10.3350/cmh.2016.22.1.160

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.

Keyword

Hepatocellular carcinoma; Portal vein tumor thrombosis; Transarterial chemoembolization; Hepatic resection; Sorafenib

MeSH Terms

Adult
Aged
Antineoplastic Agents/*therapeutic use
Carcinoma, Hepatocellular/complications/drug therapy/*therapy
Chemoembolization, Therapeutic
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Liver Neoplasms/complications/drug therapy/*therapy
Male
Middle Aged
Niacinamide/*analogs & derivatives/therapeutic use
Phenylurea Compounds/*therapeutic use
Portal Vein
Proportional Hazards Models
Retrospective Studies
Severity of Illness Index
Survival Rate
Treatment Outcome
Venous Thrombosis/*complications
Antineoplastic Agents
Niacinamide
Phenylurea Compounds