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Surgical Resection Versus Transarterial Chemoembolization for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: A Propensity Score Analysis

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The long-term survival in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) who received surgical resection (SR) or transarterial chemoembolization (TACE) remains unclear. We compared the efficacy of SR and TACE by using a propensity score analysis.

Methods

A total of 247 and 181 HCC patients with PVTT undergoing SR and TACE, respectively, were evaluated. One hundred eight pairs of matched patients were selected from each treatment arm by using a propensity score analysis.

Results

Of all patients, the estimated 1-, 3-, and 5-year survival rates of patients receiving SR and TACE were 85 versus 60 %, 68 versus 42 %, and 61 versus 33 %, respectively (p < 0.001). Patients selected for SR were significantly younger and had better liver functional reserve, performance status, and smaller tumor burden. In the propensity model, the survival benefit of SR remained significant. The estimated 1-, 3-, and 5-year survival rates of patients receiving SR and TACE were 84 versus 71 %, 69 versus 50 %, and 59 versus 35 %, respectively (p = 0.004). The two groups of patients in the propensity score analysis were similar in baseline characteristics. In the Cox proportional hazards model, patients receiving TACE had a 2.044-fold increased risk of mortality compared with patients receiving SR (95 % confidence interval: 1.284–3.252, p = 0.003).

Conclusions

For either unselected patients or patients in the propensity model, SR provides significantly better long-term survival than TACE. SR should be considered as a priority treatment in this subgroup of HCC patients.

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Acknowledgment

This study was supported by Grants from the Center of Excellence for Cancer Research at Taipei Veterans General Hospital (DOH102-TD-C-111-007), Taiwan, from Taipei Veterans General Hospital (V102C-012), Taipei, Taiwan, and from the Ministry of Education, Aim for the Top University Plan (101AC-D101), Taiwan.

Disclosure

There are no conflicts of interest in all authors.

Author information

Authors and Affiliations

  1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Po-Hong Liu MD, Yun-Hsuan Lee MD, Cheng-Yuan Hsia MD, Chia-Yang Hsu MD, Yi-You Chiou MD, Han-Chieh Lin MD & Teh-Ia Huo MD

  2. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Yi-Hsiang Huang MD, PhD

  3. Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Teh-Ia Huo MD

  4. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Po-Hong Liu MD, Yun-Hsuan Lee MD, Chia-Yang Hsu MD, Yi-Hsiang Huang MD, PhD, Han-Chieh Lin MD & Teh-Ia Huo MD

  5. Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

    Cheng-Yuan Hsia MD

  6. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Yi-You Chiou MD

  7. Department of Biostatistics, UCLA, Los Angeles, CA, USA

    Chia-Yang Hsu MD

  8. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Teh-Ia Huo MD

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  1. Po-Hong Liu MD
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Correspondence to Teh-Ia Huo MD.

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Liu, PH., Lee, YH., Hsia, CY. et al. Surgical Resection Versus Transarterial Chemoembolization for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: A Propensity Score Analysis. Ann Surg Oncol 21, 1825–1833 (2014). https://doi.org/10.1245/s10434-014-3510-3

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  • DOI: https://doi.org/10.1245/s10434-014-3510-3

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