Resection might be a meaningful choice for hepatocellular carcinoma with portal vein thrombosis

Zhang, Zun-Yi; Dong, Kai; Zhang, Erlei; Zhang, Liwei; Chen, Xiaoping; Dong, Haotian

doi:10.1097/md.0000000000018362

Cited by 27 publications

(22 citation statements)

References 42 publications

(61 reference statements)

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“…However, studies have shown that if the tumor can be completely removed, the patients can benefit from hepatectomy although HCC beyond Milan criteria [22] [23]. If the tumor and PVTT can be completely removed, patients can also obtain longer survival time and higher quality of life [7]. Peng's study showed that the 1-, 3-, 5-year survival rate of PVTT patients in hepatectomy and TACE group were 42.0%, 14.1%, 11.1% and 37.8%, 7.3%, 0.5%, respectively.…”

Section: Hepatectomymentioning

confidence: 99%

“…However, approximately 35% -45% of advanced HCC accompanied by portal vein tumor thrombosis (PVTT) [2] [5] [6] which can cause several severe prognosis-related complications such as portal hypertension, upper gastrointestinal hemorrhage and hepatic encephalopathy. A systematic review has shown that the median overall survival (mOS) of advanced HCC patients with PVTT is only about 2.7 months, significantly lower than that of patients without PVTT in which mOS is 24.4 months [7]. According to current guidelines, sorafenib is still recommended as the first-line treatment for HCC with PVTT [2], and this recommendation is based on two phase III clinical trials (SHARP and ORIENTAL)…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Shi¹,

Shen²,

Mou³

et al. 2020

JCT

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The prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is very poor although sorafenib is recommended as the first-line treatment. Therefore, an effective treatment regime is needed for treating HCC with PVTT. This review summarized seven potential treatment regimes which including transarterial chemoembolization (TACE), TACE combined with sorafenib, TACE combined with radiotherapy (RT), hepatectomy, hepatic arterial infusion chemotherapy (HAIC), HAIC combined with sorafenib and HAIC combined with RT in the treatment of HCC with PVTT. In conclusion, hepatectomy or the combination of HAIC and sorafenib may be a more effective modality in the treatment of HCC patients with type I-II PVTT. HAIC combined with or without sorafenib/RT or the combination of RT and TACE is an alternative treatment choice for HCC patients with type III-IV PVTT. Further randomized controlled studies are warranted.

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Section: Hepatectomymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Shi¹,

Shen²,

Mou³

et al. 2020

JCT

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“…However, in clinical reality, a high proportion of patients with PVTT are not treated strictly according to the BCLC algorithm but rather undergo individualized therapies, including resection, transarterial chemoembolization (TACE), selective internal radiation therapy (SIRT), or best supportive care (BSC) [11,12]. Moreover, several studies from Asia indicate that well-selected patients might benefit from such alternative therapies [13][14][15]. However, there is no consensus regarding how to identify these patients, and the level of evidence supporting such alternative treatments is low, especially among Western patients.…”

Section: Introductionmentioning

confidence: 99%

The impact of portal vein tumor thrombosis on survival in patients with hepatocellular carcinoma treated with different therapies: A cohort study

et al. 2021

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Background Portal vein tumor thrombosis (PVTT) is a frequent complication of hepatocellular carcinoma (HCC), which leads to classification as advanced stage disease (regardless of the degree of PVTT) according to the Barcelona Clinic Liver Cancer Classification. For such patients, systemic therapy is the standard of care. However, in clinical reality, many patients with PVTT undergo different treatments, such as resection, transarterial chemoembolization (TACE), selective internal radiation therapy (SIRT), or best supportive care (BSC). Here we examined whether patients benefited from such alternative therapies, according to the extent of PVTT. Methods This analysis included therapy-naïve patients with HCC and PVTT treated between January 2005 and December 2016. PVTT was classified according to the Liver Cancer study group of Japan as follows: Vp1 = segmental PV invasion; Vp2 = right anterior or posterior PV; Vp3 = right or left PV; Vp4 = main trunk. Overall survival (OS) was analyzed for each treatment subgroup considering the extent of PVTT. We performed Cox regression analysis with adjustment for possible confounders. To further attenuate selection bias, we applied propensity score weighting using the inverse probability of treatment weights. Results A total of 278 treatment-naïve patients with HCC and PVTT were included for analysis. The median observed OS in months for each treatment modality (resection, TACE/SIRT, sorafenib, BSC, respectively) was 32.4, 8.1, N/A, and 1.7 for Vp1; 10.7, 6.9, 5.5, and 1.2 for Vp2; 6.6, 7.5, 2.9, and 0.6 for Vp3; and 8.0, 3.6, 5.3, and 0.7 for Vp4. Thus, the median OS in the resection group in case of segmental PVTT (Vp1) was significantly longer compared to any other treatment group (all p values <0.01). Conclusions Treatment strategy for HCC with PVTT should not be limited to systemic therapy in general. The extent of PVTT should be considered when deciding on treatment alternatives. In patients with segmental PVTT (Vp1), resection should be evaluated.

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“…With the development of treatment modalities and perioperative management, aggressive therapies (including but not limited to liver resection, TACE, and radiofrequency ablation) are no longer contraindications, instead offering alternative treatment options for patients with advanced HCC (11,12). Notably, a growing number of studies have advocated the application of liver resection and TACE in patients with portal vein invasion (13,14).…”

Section: Introductionmentioning

confidence: 99%

Identifying optimal candidates for liver resection or transarterial chemoembolisation in patients with unresectable hepatocellular carcinoma

Zhao¹,

Zhang²,

Wang³

et al. 2020

Ann Transl Med

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Background: Recommended as the first-line treatment for advanced unresectable hepatocellular carcinoma (HCC), sorafenib has been shown to prolong median overall survival (OS) for patients. However, advanced HCC sees high heterogeneity across patient groups. Recently, a growing number of studies have indicated surgical resection and transarterial chemoembolisation (TACE) to perform well in patients with portal vein tumor thrombosis (PVTT). The aim of this study was to compare the outcomes of liver resection and TACE and to identify prognostic factors related to OS for BCLC stage C patients with performance status (PS) 1 who have a single tumor but no vascular invasion or extrahepatic spread.Methods: A total of 323 consecutive patients in BCLC stage C with PS 1 who had only one tumor and no vascular invasion or extrahepatic spread were enrolled in this retrospective study, regardless of tumor size.Survival analyses were performed using the Kaplan-Meier analysis, and statistical differences between the TACE and sorafenib groups were examined by the log-rank test. Univariate and multivariate Cox regression analyses were performed to investigate the prognostic factors for OS.Results: Based on the Kaplan-Meier curves, patients treated with surgical resection showed a better OS than those who underwent TACE, with OS at 1, 3, and 5 years (85.7%, 48.8%, and 33.3% vs. 66.6%, 21.8%, and 13.4%, respectively; log-rank P<0.001). Univariate and multivariate analyses demonstrated that tumor size, albumin, bilirubin, Child-Pugh score, and treatment method were significant prognostic factors for OS.According to the subgroup analyses based on tumor size, there were significant differences in OS among overall subsets between patients who underwent hepatectomy and those who underwent TACE therapy.Conclusions: Liver resection had a better prognostic performance than TACE and should be put forward as an alternative treatment modality to TACE for BCLC stage C patients with PS 1 who have a single tumor and no vascular invasion or extrahepatic spread.

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Resection might be a meaningful choice for hepatocellular carcinoma with portal vein thrombosis

Cited by 27 publications

References 42 publications

Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

The impact of portal vein tumor thrombosis on survival in patients with hepatocellular carcinoma treated with different therapies: A cohort study

Identifying optimal candidates for liver resection or transarterial chemoembolisation in patients with unresectable hepatocellular carcinoma

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