Medical Oncology

, Volume 29, Issue 4, pp 2992–2997 | Cite as

Transarterial chemoembolization compared with conservative treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus: using a new classification

  • Zhi-Jie Niu
  • Yi-Long MaEmail author
  • Ping Kang
  • Sheng-Qiu Ou
  • Zhi-Bin Meng
  • Zhi-Kun Li
  • Feng Qi
  • Chang Zhao
Original Paper


We aimed to compare the survival benefit of transarterial chemoembolization (TACE) with conservative treatment for patients with advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT), furthermore, to reveal which PVTT types benefit from TACE treatment. From August 2007 to January 2010, a prospective controlled study was performed on consecutive patients with advanced HCC and PVTT. Of a total of 150 patients, 115 were treated with TACE (lipiodol and anticancer agents ± gelatin sponge embolization), and 35 who refused to accept the procedure were treated with conservative treatment. We performed survival analysis of the two treatment groups and then stratified by a new classification of PVTT that was divided into four types. Overall survival was significantly better in the TACE group than in the conservative group (8.67 months vs. 1.4 months, P < 0.001). The overall median survival for types I–IV PVTT were 12.0, 8.3, 5.0, and 2.43 months (P < 0.01). On subgroup analysis of PVTT, the median survival in the TACE group compared with conservative group for type I, II, III, and IV PVTT was 19.0 months versus 4.0 months, 11.0 months versus 1.43 months, 7.1 months versus 1.3 months, and 4.0 months versus 1.0 months, respectively (P < 0.01). The TACE group had significantly better survival than the conservative group for different extent of PVTT. TACE is an effective treatment mode compared with conservative treatment for HCC and PVTT and may provide a significantly better survival benefit for different extent of PVTT.


Hepatocellular carcinoma Transarterial chemoembolization Portal vein tumor thrombus classification Prognosis 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.PubMedCrossRefGoogle Scholar
  2. 2.
    Bruix J, Llovet JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology. 2002;35:519–24.PubMedCrossRefGoogle Scholar
  3. 3.
    Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999;19:329–38.PubMedCrossRefGoogle Scholar
  4. 4.
    Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma: conclusions of the Barcelona-2000 EASL Conference. J Hepatol. 2001;35:421–30.PubMedCrossRefGoogle Scholar
  5. 5.
    Llovet JM, Real MI, Montaña X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002;359:1734–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Lee H-S, Kim JS, Choi IJ, et al. The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction. Cancer. 1997;79:2087–94.PubMedCrossRefGoogle Scholar
  7. 7.
    Georgiades CS, Hong K, D’Angelo M, Geschwind JF. Safety and efficacy of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma and portal vein thrombosis. J Vasc Interv Radiol. 2005;16:1653–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Kim KM, Kim JH, Park IS, et al. Reappraisal of repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein invasion. J Gastroenterol Hepatol. 2009;24:806–14.PubMedCrossRefGoogle Scholar
  9. 9.
    Jang JW, Bae SH, Choi JY, et al. A combination therapy with transarterial chemo-lipiodolization and systemic chemo-infusion for large extensive hepatocellular carcinoma invading portal vein in comparison with conservative management. Cancer Chemother Pharmacol. 2007;59:9–15.PubMedCrossRefGoogle Scholar
  10. 10.
    Wang J-H, Changchien C-S, Hu T-H, et al. The efficacy of treatment schedules according to Barcelona clinic liver cancer staging for hepatocellular carcinoma–survival analysis of 3892 patients. Eur J Cancer. 2008;44:1000–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Luo J, Guo R-P, Lai ECH, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis: a prospective comparative study. Ann Surg Oncol. 2011;18:413–20.PubMedCrossRefGoogle Scholar
  12. 12.
    Shi J, Lai ECH, Li N, et al. Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus. Ann Surg Oncol. 2010;17:2073–80.PubMedCrossRefGoogle Scholar
  13. 13.
    Shi J, Lai ECH, Li N, et al. A new classification for hepatocellular carcinoma with portal vein tumor thrombus. J Hepatobiliary Pancreat Sci. 2011;18:74–80.PubMedCrossRefGoogle Scholar
  14. 14.
    Shu-qun C, Meng-chao W, Han C, et al. Significance of typing of tumor thrombi in determination of treatment and assessment of prognosis of hepatocellular carcinoma with tumor thrombi in the portal vein. Zhonghua Yi Xue Za Zhi. 2004;84:3–5.Google Scholar
  15. 15.
    Shuqun C, Mengchao W, Han C, et al. Tumor thrombus types influence the prognosis of hepatocellular carcinoma with the tumor thrombi in the portal vein. Hepatogastroenterology. 2007;54:499–502.PubMedGoogle Scholar
  16. 16.
    Lladó L, Virgili J, Figueras J, et al. A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization. Cancer. 2000;88:50–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Allgaier HP, Deibert P, Olschewski M, et al. Survival benefit of patients with inoperable hepatocellular carcinoma treated by a combination of transarterial chemoembolization and percutaneous ethanol injection–a single-center analysis including 132 patients. Int J Cancer. 1998;79:601–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Chen SC, Hsieh MY, Chuang WL, et al. Development of portal vein invasion and its outcome in hepatocellular carcinoma treated by transcatheter arterial chemo-embolization. J Gastroenterol Hepatol. 1994;9:1–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Carr BI, Kondragunta V, Buch SC, et al. Therapeutic equivalence in survival for hepatic arterial chemoembolization and yttrium 90 microsphere treatments in unresectable hepatocellular carcinoma: a two-cohort study. Cancer. 2010;116:1305–14.PubMedCrossRefGoogle Scholar
  20. 20.
    Shi M, Chen J-A, Lin X-J, et al. Transarterial chemoembolization as initial treatment for unresectable hepatocellular carcinoma in southern China. World J Gastroenterol. 2010;16:264–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Cabibbo G, Enea M, Attanasio M, et al. A meta-analysis of survival rates of untreated patients in randomized clinical trials of hepatocellular carcinoma. Hepatology. 2010;51:1274–83.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Zhi-Jie Niu
    • 1
  • Yi-Long Ma
    • 2
    Email author
  • Ping Kang
    • 2
  • Sheng-Qiu Ou
    • 2
  • Zhi-Bin Meng
    • 2
  • Zhi-Kun Li
    • 2
  • Feng Qi
    • 2
  • Chang Zhao
    • 2
  1. 1.Department of PostgraduateGuangxi Medical UniversityNanningPeople’s Republic of China
  2. 2.Tumor Hospital of Guangxi Autonomous RegionNanningPeople’s Republic of China

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