Transarterial Chemoembolization for the Treatment of Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: Prognostic Factors in a Single-Center Study of 188 Patients

Abstract

Transarterial chemoembolization (TACE) could achieve a better survival benefit than conservative treatment for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). In this retrospective study, all HCC patients with Child-Pugh score <7 and PVTT who were consecutively admitted to our center between January 2006 and June 2012 and underwent TACE were enrolled. The efficacy and safety of TACE were analyzed. Prognostic factors were determined by Cox regression analysis. Of the 188 patients included, 89% had hepatitis B virus infection, 100% were at Barcelona Clinic Liver Cancer stage C, and 81% (n = 152) and 19% (n = 36) were at Child-Pugh classes A and B, respectively. The incidence of procedure-related complications was 88%. No procedure-related death was found. The median overall survival was 6.1 months. Type of PVTT (hazard ratio [HR] = 2.806), number of tumor lesions (HR = 2.288), Child-Pugh class (HR = 2.981), and presence of metastasis (HR = 1.909) were the independent predictors of survival. In conclusion, TACE could be selectively used for the treatment of advanced HCC with PVTT. But a high rate of postoperative adverse events should not be undermined in spite of no procedure-related death. Preoperative type of PVTT, number of tumor lesions, Child-Pugh class, and metastasis could predict the prognosis of these patients.

Prognostic Significance of18F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study

“…In the patient group with a TLR greater than 2.0, patients treated with TACE showed a significantly worse PFS and OS than patients treated with CCRT even after adjusting for tumor size and number. TACE is considered as the treatment of choice for intermediate-to-advanced HCC without extrahepatic metastases (1,4,5). However, it could be that it is insufficient for achieving a complete response in large advanced HCCs (23).…”

“…With only about 30% of patients able to undergo curative treatments, most HCC patients are referred for noncurative treatments (1,3). For intermediate-to-advanced-stage HCC patients without extrahepatic metastasis, transarterial chemoembolization (TACE) is the first-line treatment (1,4,5); however, diverse treatment modalities have been used to improve the treatment response and prognosis (6,7). Local radiotherapy has been effective in controlling HCC progression (8), and concurrent intraarterial chemotherapy with external-beam radiotherapy (CCRT) has recently been considered as an attractive alternative treatment strategy for locally advanced HCC (9-11).…”

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

“…Currently, evidence suggests that TACE treatment [59, 60] can be safely provided if patients have good liver function and collateral blood circulation around the obstructed portal vein which has already departed in hepatic hilar region. The mortality rate in the perioperative period is less than 1.2%, and the syndrome occurrence rate after TACE is 28.9%-94%.…”

Portal Vein Stenting Combined with Iodine-125 Seeds Endovascular Implantation Followed by Transcatheter Arterial Chemoembolization for Treatment of Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus

“…However, PVTT limits the effect of TACE on HCC and has a strong negative impact on the therapeutic effect [10]. Moreover, TACE will inevitably embolize some part of the blood supplies of normal liver tissues and increase the risk of liver failure.…”