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Lipiodol deposition in portal vein tumour thrombus predicts treatment outcome in HCC patients after transarterial chemoembolisation

  • Zhiwen Yang
  • Ruhai Zou
  • Yun Zheng
  • Jiliang Qiu
  • Jingxian Shen
  • Yadi Liao
  • Yuanping Zhang
  • Chenwei Wang
  • Yongjin Wang
  • Yichuan Yuan
  • Kai Li
  • Dinglan Zuo
  • Wei He
  • Wenwu Liu
  • Binkui Li
  • Yunfei YuanEmail author
Hepatobiliary-Pancreas
  • 14 Downloads

Abstract

Objective

To study lipiodol deposition in portal vein tumour thrombus (PVTT) in predicting the treatment outcome of hepatocellular carcinoma (HCC) patients after transarterial chemoembolisation (TACE).

Methods

We retrospectively reviewed data from 379 HCC patients with PVTT who underwent TACE as the initial treatment at Sun Yat-Sen University Cancer Center from January 2008 to December 2015. Patients were grouped by positive and negative lipiodol deposition based on the extent of lipiodol deposition in PVTT. The overall survival (OS) and progression-free survival (PFS) were compared between negative and positive lipiodol deposition groups; furthermore, the value of the combinatorial evaluation of tumour responses and lipiodol deposition in PVTT in predicting prognosis was analysed in subgroup patients with stable disease (SD) after TACE.

Results

Of the 379 patients, 264 (69.7%) had negative and 115 (30.3%) had positive lipiodol deposition in PVTT after TACE. Multivariate analysis identified positive lipiodol deposition in PVTT as an independent prognostic factor for favourable OS (p = 0.001). The median OS and PFS of negative and positive lipiodol deposition groups were 4.70 vs. 8.97 months (p = 0.001) and 3.1 months vs. 5.8 months (p < 0.001). In subgroup patients, the median OS and PFS of negative and positive lipiodol deposition groups were 4.7 months vs. 10.5 months (p < 0.001) and 3.5 months vs. 7.0 months (p < 0.001), respectively.

Conclusions

The patients with positive lipiodol deposition in PVTT had a longer OS than those with negative lipiodol deposition. Furthermore, the positive lipiodol deposition in PVTT can further differentiate HCC patients with favourable prognosis from SD patients.

Key Points

• Lipiodol deposition in PVTT is a prognostic indicator for HCC patients after TACE treatment.

• Positive lipiodol deposition in PVTT is associated with a better prognosis.

Keywords

Hepatocellular carcinoma Lipiodol Chemoembolisation Prognosis 

Abbreviations

ALBI

Albumin-Bilirubin

CI

Confidence interval

CR

Complete response

CT

Computed tomography

ECOG

Eastern Cooperative Oncology Group

HCC

Hepatocellular carcinoma

MR

Magnetic resonance

mRECIST

The Modified Response Evaluation Criteria in Solid Tumors

OS

Overall survival

PD

Progressive disease

PFS

Progression-free survival

PR

Partial response

PVTT

Portal vein tumour thrombus

SD

Stable disease

TACE

Transarterial chemoembolisation

Notes

Acknowledgments

We thank Mr. Filip Ivkovic from European Society of Radiology for his help with the editing of the language.

Funding

This study has received funding from the National Natural Science Foundation of China (No. 81372571), the State “973 Program” of China (No. 2014CB542005), the Sun Yat-Sen University Clinical Research 5010 Program (No. 2012010), and the Fundamental Research Funds for the Central Universities (No. 17ykzd34).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Yunfei Yuan.

Conflict of interest

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from patients in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

Supplementary material

330_2019_6157_MOESM1_ESM.docx (25.8 mb)
ESM 1 Supplementary Figure 1. Prognostic significance of overall tumour responses. The radiological tumour responses in hepatocellular carcinoma patients after TACE were evaluated according to the Modified Response Evaluation Criteria in Solid Tumors. The median OS times for patients with PR, SD, and PD were 7.63 months, 6.0 months, and 3.8 months, respectively (log-rank test, p = 0.001). Supplementary Figure 2. Prognostic significance of lipiodol deposition in PVTT for patients with various PVTT stages. A Overall survival (OS) of patients with PVTT stage-I, stage-II, or stage-III+IV, the median OS were 10.0 months, 6.1 months, and 5.0 months, respectively (p = 0.020). OS of groups with negative and positive lipiodol deposition in patients with (B) PVTT stage-I, the median OS were 9.2 months and 10.5 months (p = 0.749), respectively; C PVTT stage-II, the median OS were 4.9 months and 8.2 months (p = 0.0024), respectively and (D) PVTT stage-III+IV, the median OS were 4.3 months and 8.5 months (p = 0.0002), respectively. Supplementary Figure 3. Prognostic significance of extrahepatic metastasis. A Overall survival (OS) of patients with or without lung metastasis, the median OS were 4.27 vs. 6.07 months (p = 0.027), respectively. B OS of patients with or without lymph nodes metastasis, the median OS were 5.07 vs. 6.17 months (p = 0.579), respectively. Supplementary Figure 4. Extent of lipiodol deposition in PVTT based on CT images after TACE for HCC patients with PVTT. CT scans obtained in two HCC patients with no lipiodol deposits in PVTT during follow-up after treatment. Scans obtained during the non-contrast CT scan (A, B) and portal vein phases (C, D). A, C patient 1; B. D patient 2. Supplementary Figure 5. Extent of lipiodol deposition in PVTT based on CT images after TACE for HCC patients with PVTT. CT scans obtained in four HCC patients with spots of lipiodol deposits in PVTT. Scans obtained during the non-contrast CT scan (AD) and portal vein phases (EH). A, E patient 1; B, F patient 2; C, G patient 3; D, H patient 4. Supplementary Figure 6. Extent of lipiodol deposition in PVTT based on CT images after TACE for HCC patients with PVTT. CT scans obtained in four HCC patients with massive, indicating clumps of lipiodol deposits in PVTT. Scans obtained during the non-contrast CT scan (AD) and portal vein phases (EH). A, E patient 1; B, F patient 2; C, G patient 3; D, H patient 4. (DOCX 25.7 mb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Zhiwen Yang
    • 1
    • 2
  • Ruhai Zou
    • 1
    • 3
  • Yun Zheng
    • 1
    • 2
  • Jiliang Qiu
    • 1
    • 2
  • Jingxian Shen
    • 1
    • 4
  • Yadi Liao
    • 1
    • 2
  • Yuanping Zhang
    • 1
    • 2
  • Chenwei Wang
    • 1
    • 2
  • Yongjin Wang
    • 1
    • 2
  • Yichuan Yuan
    • 1
    • 2
  • Kai Li
    • 1
    • 2
  • Dinglan Zuo
    • 1
  • Wei He
    • 1
    • 2
  • Wenwu Liu
    • 1
    • 2
  • Binkui Li
    • 1
    • 2
  • Yunfei Yuan
    • 1
    • 2
    Email author
  1. 1.State Key Laboratory of Oncology in South ChinaSun Yat-Sen University Cancer CenterGuangzhouChina
  2. 2.Department of Hepatobiliary OncologySun Yat-Sen University Cancer CenterGuangzhouChina
  3. 3.Department of UltrasoundSun Yat-Sen University Cancer CenterGuangzhouChina
  4. 4.Department of Medical ImagingSun Yat-Sen University Cancer CenterGuangzhouChina

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