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Transarterial chemoembolization of hepatocellular carcinoma with segmental portal vein tumour thrombus

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Abstract

Objectives

To evaluate the clinical outcome and safety of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with segmental or subsegmental portal vein tumour thrombus (sPVTT) in patients with preserved hepatic function, and to address the efficacy of additional chemoinfusion after TACE (TACE+CI).

Methods

From January 2003 to December 2012, TACE was conducted on 81 patients with Child-Pugh score ≤7 who had HCC with sPVTT. Thirty-one of them underwent TACE+CI. The overall survival (OS) and serious adverse events (SAEs) were evaluated. The efficacy of TACE+CI was appraised after adjustment with inverse probability of treatment weighting (IPTW).

Results

The OS after TACE (median, 15.5 months) was significantly related with aspartate aminotransferase (hazard ratio [HR], 1.011), modified Barcelona Clinic Liver Cancer (BCLC) stage D (HR, 2.841), extrahepatic spread (HR, 4.862), and TACE+CI (HR, .367). The SAE incidence was significantly associated with modified BCLC stages (HR, 10.174 [proper-C] and 24.000 [D]). After IPTW adjustment, TACE+CI significantly improved OS (p = .028; HR, .511), but the SAE incidence was not significantly altered (p = .737; HR, .819).

Conclusions

TACE can be an effective and safe treatment option for HCC with sPVTT in patients with preserved hepatic function. Furthermore, additional chemoinfusion can enhance the therapeutic efficacy while maintaining the safety.

Key Points

• TACE is effective and safe for treating HCC with sPVTT.

• Modified BCLC stages can stratify the risk and benefit of TACE.

• Additional chemoinfusion can enhance the therapeutic efficacy while maintaining the safety.

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Abbreviations

TACE:

Transarterial chemoembolization

HCC:

Hepatocellular carcinoma

BCLC:

Barcelona Clinic Liver Cancer

ECOG:

Eastern Cooperation Oncology Group

PVTT:

Portal vein tumour thrombus

sPVTT:

Segmental or subsegmental portal vein tumour thrombus

CT:

Computed tomography

cTACE:

Conventional transarterial chemoembolization

TACE+CI:

Transarterial chemoembolization plus additional transarterial chemoinfusion

CSPH:

Clinically significant portal hypertension

EHS:

Extrahepatic spread

MELD:

Model for End-stage Liver Disease

OS:

Overall survival

AE:

Adverse event

CTCAE:

Common Terminology Criteria for Adverse Events

SAE:

Serious adverse event

IPTW:

Inverse probability of treatment weighting

CI:

Confidence interval

AST:

Aspartate aminotransferase

HR:

Hazard ratio

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Acknowledgements

The scientific guarantor of this publication is Hyo-Cheol Kim. 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. The authors state that this work has not received any funding. Medical Research Collaborating Center of Seoul National University Hospital kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No subjects or cohorts have been previously reported.

Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Section of Interventional Radiology, Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jin Woo Choi, Hyo-Cheol Kim, Hwan Jun Jae, Saebeom Hur, Myungsu Lee & Jin Wook Chung

  2. Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

    Jeong-Hoon Lee, Su Jong Yu, Yoon Jun Kim & Jung-Hwan Yoon

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  1. Jin Woo Choi
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Correspondence to Hyo-Cheol Kim.

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Choi, J.W., Kim, HC., Lee, JH. et al. Transarterial chemoembolization of hepatocellular carcinoma with segmental portal vein tumour thrombus. Eur Radiol 27, 1448–1458 (2017). https://doi.org/10.1007/s00330-016-4511-3

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  • DOI: https://doi.org/10.1007/s00330-016-4511-3

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