Proposal of selection criteria for operative resection of hepatocellular carcinoma with inferior vena cava tumor thrombus incorporating hepatic arterial infusion chemotherapy

Kasai, Yosuke; Hatano, Etsuro; Seo, Satoru; Taura, Kojiro; Yasuchika, Kentaro; Okajima, Hideaki; Kaido, Toshimi; Üemoto, Shinji

doi:10.1016/j.surg.2017.05.011

Cited by 24 publications

(39 citation statements)

References 34 publications

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“…No RCTs have demonstrated the efficacy of adjuvant or neoadjuvant therapy to improve outcomes after resection for HCC, with or without TT, and the outcomes were similar in patients with and those without preoperative treatment in the present study. However, preoperative and postoperative chemotherapy, including HAIC, could potentially be used to identify patients with aggressive tumour progression and to prevent recurrence after resection. In addition, favourable local control has been reported recently for radioembolization and external‐beam radiotherapy for HCC with macrovascular invasion, and could be a preoperative treatment option.…”

Section: Discussionmentioning

confidence: 99%

Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium

et al. 2020

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Background Hepatocellular carcinoma (HCC) with tumour thrombus (TT) in the inferior vena cava (IVC) or right atrium (RA) is a rare advanced disease state with a poor prognosis. The aim of this study was to examine survival after surgical resection. Methods Patients with HCC and TT of either the IVC or RA, who underwent liver resection between February 1997 and July 2017, were included. Their short‐ and long‐term outcomes and surgical details were analysed retrospectively. Results Thirty‐seven patients were included; 16 patients had TT in the IVC below the diaphragm, eight had TT in the IVC above the diaphragm, and 13 had TT entering the RA. Twelve patients had advanced portal vein TT (portal vein invasion (Vp) greater than Vp3 and Vp4), ten had bilobar disease, and 12 had extrahepatic disease. There were no in‐hospital deaths, although two patients died within 90 days. Median survival did not differ between patients who had resection with curative intent (18·7 months) and those with residual tumour in the lung only (20·7 months), but survival was poor for patients with residual tumour in the liver (8·3 months). Conclusion Liver resection with thrombectomy for advanced HCC with TT in the IVC or RA is safe and feasible, leading to moderate survival.

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Section: Discussionmentioning

confidence: 99%

Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium

et al. 2020

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“…Indeed, 1-year recurrence-free survival in studies where surgery was applied ranged from 26% to 44% [19,20,31,32].…”

Section: Discussionmentioning

confidence: 99%

“…Among the 18 studies, 8 were single arm studies [19][20][21][22][31][32][33][34] that were categorized into the surgery subgroup, another 8 were single arm studies [24,[35][36][37][38][39][40][41] categorized into the EBRT subgroup, and 2 were controlled studies [42,43] comprising 2 cohorts that compared surgery and EBRT. Eight studies (44%) were from mainland China, 6 from Japan (33%), 2 from Korea (11%), and 1 from Taiwan All rights reserved.…”

Section: Study Inclusion and General Informationmentioning

confidence: 99%

“…Following advances in surgical techniques, recent studies showed that surgical management of these patients produced better survival outcomes than non-surgical alternatives. However, since surgical approaches for this group of patients are invasive, complete resection is not always possible, and it is necessary to balance between effectiveness and avoiding complications [19][20][21]. Although transarterial chemoembolization (TACE) is the most common local treatment modality, its oncologic outcome is unsatisfactory given its median survival of 4.2-4.7 months [22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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Surgery versus external beam radiotherapy for hepatocellular carcinoma involving the inferior vena cava or right atrium: A systematic review and meta-analysis

Lee

Park

Seo

et al. 2020

Preprint

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Purpose: As the treatment efficacy of systemic therapy for patients with advanced stage HCC is insufficient, locoregional therapies are performed in the clinical practice. We investigated the efficacy and safety of two most potent therapies, surgery and external beam radiotherapy (EBRT), in patients with HCC involving the IVC and/or right atrium (RA) through comparative meta-analysis. Method: A systematic search of Pubmed, MEDLINE, EMBASE, and the Cochrane library was performed for entries up to July 2020. The primary endpoints were 1 and 2 year overall survival (OS) rates, while secondary endpoints were response rate, local control rate, and grade >=3 toxicities. Results: Eighteen studies with 22 cohorts were included, encompassing 755 patients. The pooled median OS and 1 and 2 year OS rates were 14.2 months, 55.6%, and 27.4%, respectively. The pooled median OS in the surgery and EBRT arms were 15.3 and 11.7 months, respectively. The pooled 1 year OS rate of the surgery arm was significantly higher than that of the EBRT arm (62.4%, 95% CI: 53.8–70.3 vs. 48.8%, 95% CI: 40.9–56.8; p=0.023). However, the 2 year OS rates were comparable (26.9%, 95% CI: 20.7–34.2 vs. 27.5%, 95% CI: 19.7–37.1; p=0.913). The pooled response and local control rates in the EBRT arm were 74.3% and 87.2%, respectively. In the surgical arm, the perioperative mortality and grade >=3 complication rates were 0–7.6% and 3.9–67%, respectively. Grade >=3 complications and radiation induced liver disease were rarely observed in the EBRT arm. Conclusions: Both surgery and EBRT are effective treatment options for patients with HCC involving IVC/RA invasion. Outcomes and safety should be further evaluated in well-controlled clinical trials.

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“…Recently, several series of HCC patients with IVCTT were documented with promising prognostic outcomes when they received aggressive surgery, with an MST ranging from 18.1 to 30.8 months [3-5, 9, 19-21]. In selected settings, patients might even gain long-term survival benefits from curative surgery such as in case of patients with good liver function reservoir, resectable primary tumor and vascular thrombus, and inexistence of extrahepatic metastases [4,20]. erefore, surgical resection of HCC with IVCTT should be considered as curative treatment option.…”

Section: Introductionmentioning

confidence: 99%

Nomogram for Predicting Long-Term Survival after Synchronous Resection for Hepatocellular Carcinoma and Inferior Vena Cava Tumor Thrombosis: A Multicenter Retrospective Study

Bai

Zeng

et al. 2020

Journal of Oncology

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Background. Although surgery for hepatocellular carcinoma (HCC) complicated with inferior vena cava tumor thrombus (IVCTT) may improve survival for some patients, prognostic markers remain elusive because of its rarity. We constructed a prognostic nomogram which predicts individualized survival benefit of curative-intent surgery for HCC patients with IVCTT. Methods. According to abdominothoracic anatomy of inferior vena cava (IVC), IVCTT can be divided into 3 types: inferior diaphragmic (ID), superior diaphragmic (SD), and intracardiac type (IC). Data of 64 HCC patients with IVCTT who underwent curative-intent surgery between 2008 and 2015 in four centers in China were analyzed retrospectively. Univariate and multivariate Cox regression analyses were conducted to select variables for the construction of a prognostic nomogram. Predictive accuracy and discriminative ability were examined by concordance index (C-index) and calibration curve. Results. Of 64 patients in the IVCTT classification, 37 (57.8%) were classified as ID type, 15 (23.4%) as SD type, and 12 (18.8%) as IC type. e 1-, 2-, 3-, and 5year disease-specific survival (DSS) rates for patients in ID, SD, and IC groups were 94.4%, 55.6%, 71.4%, and 30.0%; 27.8%, 21.4%, 7.1%, and 0%; and 8.3%, 0%, 0%, and 0%, respectively. Independent factors included in the nomogram were ECOG performance status, AFP level ≥ 400 μg/L, tumor size ≥ 10 cm, portal vein tumor thrombosis, and IVCTT classification. e C-index of the nomogram was 0.812 (95% CI 0.761-0.873). e calibration plot for DSS probability showed excellent agreement between the prediction by nomogram and actual observation. Conclusions. Curative-intent surgery should be carefully evaluated and suggested according to our novel IVCTT classification. We have developed a visual web-based nomogram model to predict oncological prognosis of curative-intent surgery for HCC patients with IVCTT.

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Proposal of selection criteria for operative resection of hepatocellular carcinoma with inferior vena cava tumor thrombus incorporating hepatic arterial infusion chemotherapy

Cited by 24 publications

References 34 publications

Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium

Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium

Surgery versus external beam radiotherapy for hepatocellular carcinoma involving the inferior vena cava or right atrium: A systematic review and meta-analysis

Nomogram for Predicting Long-Term Survival after Synchronous Resection for Hepatocellular Carcinoma and Inferior Vena Cava Tumor Thrombosis: A Multicenter Retrospective Study

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