Transarterial chemoembolization of hepatocellular carcinoma with segmental portal vein tumour thrombus
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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.
• 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.
KeywordsHepatocellular carcinoma Portal vein tumour thrombus Transarterial chemoembolization Chemoinfusion Barcelona Clinic Liver Cancer Stage
Barcelona Clinic Liver Cancer
Eastern Cooperation Oncology Group
Portal vein tumour thrombus
Segmental or subsegmental portal vein tumour thrombus
Conventional transarterial chemoembolization
Transarterial chemoembolization plus additional transarterial chemoinfusion
Clinically significant portal hypertension
Model for End-stage Liver Disease
Common Terminology Criteria for Adverse Events
Serious adverse event
Inverse probability of treatment weighting
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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