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Efficacy and safety of preoperative chemoembolization for resectable hepatocellular carcinoma with portal vein invasion: a prospective comparative study

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the outcomes of preoperative transarterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC) with portal vein invasion.

Methods

From February 2006 to July 2011, 320 patients initially diagnosed with resectable HCC and portal vein invasion were prospectively non-randomized into two arms. In the immediate resection arm (Arm 1, n = 205) patients received immediate surgical resection. 115 patients were included in the preoperative TACE arm (Arm 2), and eventually 85 patients underwent TACE followed by surgical resection.

Results

The 1-, 3- and 5-year overall survival rates were 48.3 %, 18.7 % and 13.9 % for Arm 1 and 61.2 %, 31.7 % and 25.3 % for Arm 2 (P = 0.001), respectively. In the subgroup analysis of types I and II portal vein tumour thrombus (PVTT), the preoperative TACE arm demonstrated significantly better survival rates than the immediate resection arm (P I  = 0.001, P II  = 0.036). However, no significant difference was found for patients with type III PVTT (P III  = 0.684). No significant difference was found between the two arms in terms of complications and mortality.

Conclusions

Preoperative TACE seems to confer a survival benefit for resectable HCC with PVTT, especially for types I and II PVTT, and preoperative TACE should therefore be recommended as a routine procedure.

Key Points

• Preoperative TACE improves the clinical outcomes for patients with PVTT

• Preoperative TACE could significantly improve the rate of en bloc thrombectomy

• Preoperative TACE does not increase the related adverse events

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Abbreviations

CDUS:

Colour Doppler ultrasound

CR:

Complete response

CT:

Computed tomography

EASL:

European Association for the Study of the Liver guidelines

HCC:

Hepatocellular carcinoma

ICG-R15:

Indocyanine green retention rate in 15 min

IOUS:

Intra-operative ultrasound

MRI:

Magnetic resonance imaging

PD:

Progressive disease

PR:

Partial response

PVTT:

Portal vein tumour thrombus

SD:

Stable disease

TACE:

Transarterial chemoembolization

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Acknowledgments

Yong-Fa Zhang and Rong-Ping Guo contributed equally to this work and are considered co-first authors. The scientific guarantor of this publication is Dr. Ming Shi. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding from the National Natural Science Foundation of China [No. 81272639, No. 81572385], and the Fundamental Research Funds for the Central Universities of China [No. 13ykzd24]. One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. None of the study subjects or cohorts has been reported previously. Methodology: prospective, case-control study, performed at one institution.

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Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, Guangzhou, China

    Yong-Fa Zhang, Rong-Ping Guo, Ru-Hai Zou, Jing-Xian Shen, Wei Wei, Shao-Hua Li, Han-Yue OuYang, Li Xu, Xiang-Ming Lao & Ming Shi

  2. Department of Hepatobiliary Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, 510060, People’s Republic of China

    Yong-Fa Zhang, Rong-Ping Guo, Wei Wei, Shao-Hua Li, Han-Yue OuYang, Li Xu, Xiang-Ming Lao & Ming Shi

  3. Department of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China

    Ru-Hai Zou

  4. Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China

    Jing-Xian Shen

  5. Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China

    Yong-Fa Zhang, Rong-Ping Guo, Ru-Hai Zou, Jing-Xian Shen, Wei Wei, Shao-Hua Li, Han-Yue OuYang, Li Xu, Xiang-Ming Lao & Ming Shi

  6. Department of Medical Oncology of the First Affiliated Hospital of the University of South China, Hengyang, China

    Hong-Bo Zhu

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  1. Yong-Fa Zhang
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Correspondence to Ming Shi.

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Zhang, YF., Guo, RP., Zou, RH. et al. Efficacy and safety of preoperative chemoembolization for resectable hepatocellular carcinoma with portal vein invasion: a prospective comparative study. Eur Radiol 26, 2078–2088 (2016). https://doi.org/10.1007/s00330-015-4021-8

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  • DOI: https://doi.org/10.1007/s00330-015-4021-8

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