Abstract
Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is associated with a poor prognosis. New therapeutic modalities, such as continuous hepatic arterial infusion chemotherapy (CHAIC), have recently been reported to be promising strategies. The aim of this study was to evaluate the clinical characteristics, prognosis, and survival of patients with PVTT according to treatment regimen. One hundred ninety-three patients with HCC complicated with PVTT at the time of diagnosis were included in this study. All patients were newly diagnosed to have HCC and were observed from January 1992 to December 2003. CHAIC was performed using an implanted drug delivery system with low-dose cisplatin and 5-fluorouracil. Clinical characteristics, prognosis, and patient survival were analyzed by the Kaplan-Meier method and Cox's proportional hazards model. The mean age of the patients complicated with PVTT was 64.3±10.3 years (range, 20–88 years). The survival of the 193 patients with PVTT was 37.5%, 24.0%, 18.9%, and 8.3% at 1, 2, 3, and 5 years, respectively. According to treatment, the survival of patients who underwent surgical treatment was the best, followed by CHAIC, transcatheter arterial infusion/embolization, and supportive care. The 3-year survivals for each treatment regimen were 53.0%, 19.3%, 15.0%, and 4.0%, respectively. Although the survival of patients who received surgical treatment was best, such patients were restricted. There was no difference in survival between treated and untreated patients demonstrating Child-Pugh grade C. In Child B patients, treatment for HCC significantly increased survival (P<0.01). Cox's proportional hazards model revealed the Child-Pugh classification to be an independent prognostic factor for patients with HCC and PVTT (P<0.01). We conclude that the prognosis of HCC with PVTT was quite poor. The treatment did not improve the survival of Child C patients. As a result, the prevention, early diagnosis, and development of new treatment strategies are required.
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Llovet JM, Bustamante J, Castells A, Vilana R, Ayuso Mdel C, Sala M, Bru C, Rodes J, Bruix J (1999) Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 29:62–67
Pawarode A, Voravud N, Sriuranpong V, Kullavanijaya P, Patt YZ (1998) Natural history of untreated primary hepatocellular carcinoma: a retrospective study of 157 patients. Am J Clin Oncol 21:386–391
Lee HS, Kim JS, Choi IJ, Chung JW, Park JH, Kim CY (1997) The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction. A prospective controlled study. Cancer 79:2087–2094
Okuda K, Ohtsuki T, Obata H, Tomimatsu M, Okazaki N, Hasegawa H, Nakajima Y, Ohnishi K (1985) Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 56:918–928
Fujii T, Takayasu K, Muramatsu Y, Moriyama N, Wakao F, Kosuge T, Takayama T, Makuuchi M, Yamasaki S, Okazaki N (1993) Hepatocellular carcinoma with portal tumor thrombus: analysis of factors determining prognosis. Jpn J Clin Oncol 23:105–109
Sakurai M, Okamura J, Kuroda C (1984) Transcatheter chemo-embolization effective for treating hepatocellular carcinoma: A histopathologic study. Cancer 54:387–392
Bruix J (1997) Treatment of hepatocellular carcinoma. Hepatology 25:259–262
Friedman M (1983) Primary hepatocellular cancer—present results and future prospects. Int J Radiat Oncol Biol Phys 9:1841–1850
Iwamiya T, Sawada S, Ohta Y (1994) Repeated arterial infusion chemotherapy for inoperable hepatocellular carcinoma using an implantable drug delivery system. Cancer Chemother Pharmacol 33:S134–S138
Une Y, Uchino J, Yasuhara M, Misawa K, Kamiyama T, Shimamura T, Sato N, Nakajima Y, Hata Y (1993) Intra-arterial infusion chemotherapy on unresectable hepatocellular carcinoma under occlusion of hepatic arterial flow. Clin Ther 15:347–354
Toyoda H, Nakano S, Kumada T, Takeda I, Sugiyama K, Osada T, Kiriyama S, Suga T, Takahashi M (1995) The efficacy of continuous local arterial infusion of 5-fluorouracil and cisplatin through an implanted reservoir for severe advanced hepatocellular carcinoma. Oncology 52:295–299
Ando E, Yamashita F, Tanaka M, Tanigawa K (1997) A novel chemotherapy for advanced hepatocellular carcinoma with tumor thrombosis of the main trunk of the portal vein. Cancer 79:1890–1896
Itamoto T, Nakahara H, Tashiro H, Haruta N, Asahara T, Naito A, Ito K (2002) Hepatic arterial infusion of 5-fluorouracil and cisplatin for unresectable or recurrent hepatocellular carcinoma with tumor thrombosis of the portal vein. J Surg Oncol 80:143–148
Ando E, Tanaka M, Yamashita F, Kuromatsu R, Yatani S, Fukumori K, Sumie S, Yano Y, Okuda K, Sata M (2002) Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: analysis of 48 cases. Cancer 95:588–595
Llovet JM, Beaugrand M (2003) Hepatocellular carcinoma: present status and future prospects. J Hepatol 38:S136–S149
Llovet JM, Bustamante J, Castells A, Vilana R, Ayuso Mdej C, Sala M, Bru C, Rodes J, Bruix J (1999) Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 29:62–67
Chung YH, Song H, Song BC, Lee GC, Koh MS, Yoon HK, Lee YS, Sung KB, Suh DJ (2000) Combined therapy consisting of intraarterial cisplatin infusion and systemic interferon-a for hepatocellular carcinoma patients with major portal vein thrombosis or distant metastasis. Cancer 88:1986–1991
The Liver Cancer Study Group of Japan (1994) Predictive factors for long term prognosis after partial hepatectomy for patients with hepatocellular carcinoma. Cancer 74:2772–2780
Sakon M, Nagano H, Dono K, Nakamori S, Umeshita K, Yamada A, Kawata S, Imai Y, Iijima S, Monden M (2002) Combined intraarterial 5-fluorouracil and subcutaneous interferon-alpha therapy for advanced hepatocellular carcinoma with tumor thrombi in the major portal branches. Cancer 94:435–442
Meric F, Patt YZ, Curley SA, Chase J, Roh MS, Vanthey JN, Ellis LM (2000) Surgery after downstaging of unresectable hepatic tumors with intra-arterial chemotherapy. Ann Surg Oncol 7:490–495
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Takizawa, D., Kakizaki, S., Sohara, N. et al. Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: Clinical Characteristics, Prognosis, and Patient Survival Analysis. Dig Dis Sci 52, 3290–3295 (2007). https://doi.org/10.1007/s10620-007-9808-2
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DOI: https://doi.org/10.1007/s10620-007-9808-2