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



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).


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).


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).


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.


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



Transarterial chemoembolization


Hepatocellular carcinoma


Barcelona Clinic Liver Cancer


Eastern Cooperation Oncology Group


Portal vein tumour thrombus


Segmental or subsegmental portal vein tumour thrombus


Computed tomography


Conventional transarterial chemoembolization


Transarterial chemoembolization plus additional transarterial chemoinfusion


Clinically significant portal hypertension


Extrahepatic spread


Model for End-stage Liver Disease


Overall survival


Adverse event


Common Terminology Criteria for Adverse Events


Serious adverse event


Inverse probability of treatment weighting


Confidence interval


Aspartate aminotransferase


Hazard ratio



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)


  1. 1.
    Bruix J, Sherman M, American Association for the Study of Liver Diseases (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    European Association for the Study of the Liver, European Organisation for Reresarch and Treatment of Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943CrossRefGoogle Scholar
  3. 3.
    Llovet JM, Bru C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19:329–338CrossRefPubMedGoogle Scholar
  4. 4.
    Forner A, Gilabert M, Bruix J, Raoul JL (2014) Treatment of intermediate-stage hepatocellular carcinoma. Nat Rev Clin Oncol 11:525–535CrossRefPubMedGoogle Scholar
  5. 5.
    Bolondi L, Burroughs A, Dufour JF et al (2012) Heterogeneity of patients with intermediate (BCLC B) Hepatocellular Carcinoma: proposal for a subclassification to facilitate treatment decisions. Semin Liver Dis 32:348–359PubMedGoogle Scholar
  6. 6.
    Weinmann A, Koch S, Sprinzl M et al (2015) Survival analysis of proposed BCLC-B subgroups in hepatocellular carcinoma patients. Liver Int 35:591–600CrossRefPubMedGoogle Scholar
  7. 7.
    Kim HC, Lee JH, Chung JW et al (2013) Transarterial chemoembolization with additional cisplatin infusion for hepatocellular carcinoma invading the hepatic vein. J Vasc Interv Radiol 24:274–283CrossRefPubMedGoogle Scholar
  8. 8.
    Chung GE, Lee JH, Kim HY et al (2011) Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival. Radiology 258:627–634CrossRefPubMedGoogle Scholar
  9. 9.
    Miraglia R, Pietrosi G, Maruzzelli L et al (2007) Efficacy of transcatheter embolization/chemoembolization (TAE/TACE) for the treatment of single hepatocellular carcinoma. World J Gastroenterol 13:2952–2955CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Sieghart W, Hucke F, Peck-Radosavljevic M (2015) Transarterial chemoembolization: Modalities, indication, and patient selection. J Hepatol 62:1187–1195CrossRefPubMedGoogle Scholar
  11. 11.
    Xue TC, Xie XY, Zhang L, Yin X, Zhang BH, Ren ZG (2013) Transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a meta-analysis. BMC Gastroenterol 13:60CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kim KM, Kim JH, Park IS et al (2009) Reappraisal of repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein invasion. J Gastroenterol Hepatol 24:806–814CrossRefPubMedGoogle Scholar
  13. 13.
    Llovet JM, Ricci S, Mazzaferro V et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359:378–390CrossRefPubMedGoogle Scholar
  14. 14.
    Bruix J, Raoul JL, Sherman M et al (2012) Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: subanalyses of a phase III trial. J Hepatol 57:821–829CrossRefPubMedGoogle Scholar
  15. 15.
    Mathieu D, Grenier P, Larde D, Vasile N (1984) Portal vein involvement in hepatocellular carcinoma: dynamic CT features. Radiology 152:127–132CrossRefPubMedGoogle Scholar
  16. 16.
    Tublin ME, Dodd GD 3rd, Baron RL (1997) Benign and malignant portal vein thrombosis: differentiation by CT characteristics. AJR Am J Roentgenol 168:719–723CrossRefPubMedGoogle Scholar
  17. 17.
    Willatt JM, Hussain HK, Adusumilli S, Marrero JA (2008) MR imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology 247:311–330CrossRefPubMedGoogle Scholar
  18. 18.
    Kothary N, Weintraub JL, Susman J, Rundback JH (2007) Transarterial chemoembolization for primary hepatocellular carcinoma in patients at high risk. J Vasc Interv Radiol 18:1517–1526CrossRefPubMedGoogle Scholar
  19. 19.
    Choi JW, Chung JW, Cho YK et al (2014) Transarterial chemoembolization for hepatocellular carcinomas with central bile duct invasion: safety, prognosis, and predictive factors. Cardiovasc Intervent Radiol 38:937–945CrossRefPubMedGoogle Scholar
  20. 20.
    Kim SH, Kim YJ, Lee JM et al (2007) Esophageal varices in patients with cirrhosis: multidetector CT esophagography--comparison with endoscopy. Radiology 242:759–768CrossRefPubMedGoogle Scholar
  21. 21.
    Kim H, Choi D, Gwak GY et al (2009) Evaluation of esophageal varices on liver computed tomography: receiver operating characteristic analyses of the performance of radiologists and endoscopists. J Gastroenterol Hepatol 24:1534–1540CrossRefPubMedGoogle Scholar
  22. 22.
    Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:52–60CrossRefPubMedGoogle Scholar
  23. 23.
    Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European association for the study of the liver. J Hepatol 35:421–430CrossRefPubMedGoogle Scholar
  24. 24.
    Brown DB, Nikolic B, Covey AM et al (2012) Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol 23:287–294CrossRefPubMedGoogle Scholar
  25. 25.
    Imai Y, Chikayama T, Nakazawa M et al (2011) Usefulness of miriplatin as an anticancer agent for transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma. J Gastroenterol 47:179–186CrossRefPubMedGoogle Scholar
  26. 26.
    Vogl TJ, Lammer J, Lencioni R et al (2011) Liver, gastrointestinal, and cardiac toxicity in intermediate hepatocellular carcinoma treated with PRECISION TACE with drug-eluting beads: results from the PRECISION V randomized trial. AJR Am J Roentgenol 197:W562–W570CrossRefPubMedGoogle Scholar
  27. 27.
    Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199–S202CrossRefPubMedGoogle Scholar
  28. 28.
    Cleophas TJ, Zwinderman AH (2006) Clinical trials are often false positive: a review of simple methods to control this problem. Curr Clin Pharmacol 1:1–4CrossRefPubMedGoogle Scholar
  29. 29.
    Memon K, Kulik LM, Lewandowski RJ et al (2014) Comparative study of staging systems for hepatocellular carcinoma in 428 patients treated with radioembolization. J Vasc Interv Radiol 25:1056–1066CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Kulik LM, Carr BI, Mulcahy MF et al (2008) Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 47:71–81CrossRefPubMedGoogle Scholar
  31. 31.
    Kokudo N, Hasegawa K, Akahane M et al (2015) Evidence-based clinical practice guidelines for hepatocellular carcinoma: the Japan society of hepatology 2013 update (3rd JSH-HCC Guidelines). Hepatol Res 45Google Scholar
  32. 32.
    Luo J, Guo RP, Lai EC et al (2011) Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis: a prospective comparative study. Ann Surg Oncol 18:413–420CrossRefPubMedGoogle Scholar
  33. 33.
    Marrero JA, Fontana RJ, Barrat A et al (2005) Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology 41:707–716CrossRefPubMedGoogle Scholar
  34. 34.
    Sahara S, Kawai N, Sato M et al (2012) Prospective evaluation of transcatheter arterial chemoembolization (TACE) with multiple anti-cancer drugs (epirubicin, cisplatin, mitomycin c, 5-fluorouracil) compared with TACE with epirubicin for treatment of hepatocellular carcinoma. Cardiovasc Intervent Radiol 35:1363–1371CrossRefPubMedGoogle Scholar
  35. 35.
    Marelli L, Stigliano R, Triantos C et al (2007) Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol 30:6–25CrossRefPubMedGoogle Scholar
  36. 36.
    Huang M, Lin Q, Wang H et al (2016) Survival benefit of chemoembolization plus Iodine125 seed implantation in unresectable hepatitis B-related hepatocellular carcinoma with PVTT: a retrospective matched cohort study. Eur Radiol. doi: 10.1007/s00330-015-4198-x Google Scholar
  37. 37.
    Zhang YF, Guo RP, Zou RH et al (2015) Efficacy and safety of preoperative chemoembolization for resectable hepatocellular carcinoma with portal vein invasion: a prospective comparative study. Eur Radiol. doi: 10.1007/s00330-015-4021-8 Google Scholar

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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