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European Radiology

, Volume 27, Issue 4, pp 1448–1458 | Cite as

Transarterial chemoembolization of hepatocellular carcinoma with segmental portal vein tumour thrombus

  • Jin Woo Choi
  • Hyo-Cheol Kim
  • Jeong-Hoon Lee
  • Su Jong Yu
  • Yoon Jun Kim
  • Jung-Hwan Yoon
  • Hwan Jun Jae
  • Saebeom Hur
  • Myungsu Lee
  • Jin Wook Chung
Interventional

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.

Keywords

Hepatocellular carcinoma Portal vein tumour thrombus Transarterial chemoembolization Chemoinfusion Barcelona Clinic Liver Cancer Stage 

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

Notes

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.

Supplementary material

330_2016_4511_MOESM1_ESM.docx (36 kb)
Suppl. Table 1 (DOCX 35.5 kb)
330_2016_4511_MOESM2_ESM.docx (36 kb)
Suppl. Table 2 (DOCX 36 kb)
330_2016_4511_Fig5_ESM.jpg (139 kb)
Supplementary figure 1

(JPEG 139 kb)

330_2016_4511_MOESM3_ESM.tif (79 kb)
(TIFF 79 kb)

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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Jin Woo Choi
    • 1
  • Hyo-Cheol Kim
    • 1
  • Jeong-Hoon Lee
    • 2
  • Su Jong Yu
    • 2
  • Yoon Jun Kim
    • 2
  • Jung-Hwan Yoon
    • 2
  • Hwan Jun Jae
    • 1
  • Saebeom Hur
    • 1
  • Myungsu Lee
    • 1
  • Jin Wook Chung
    • 1
  1. 1.Section of Interventional Radiology, Department of Radiology, Seoul National University HospitalSeoul National University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Internal Medicine, Seoul National University HospitalSeoul National University College of MedicineSeoulRepublic of Korea

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