Abstract
Objectives
The aim of this single, randomized study was to explore the efficacy of postoperative transarterial chemoembolization (TACE) and portal vein chemotherapy (PVC) for patients with hepatocellular carcinoma (HCC) complicated by portal vein tumor thrombosis (PVTT) and to evaluate prognostic factors.
Methods
The study cohort consisted of 112 patients with HCC and PVTT randomly divided into three groups: Group A (37 patients), operation only; Group B (35 patients), operation plus TACE; Group C (40 patients), operation plus TACE and PVC. Disease-free survival rates and prognostic factors were analyzed.
Results
Most of the side effects and complications were related to the operation, catheters, and local chemotherapy and included liver decompensation (15.0%), catheter obstruction (11.6%), and nausea and loss of appetite (22.1%). The disease-free survival curve was significantly different among the three groups, as estimated by the Kaplan-Meier method (both P < 0.05). Group C showed a significantly higher disease-free survival rate than Group A (P < 0.05), but no statistical differences were found between group A and group B, and group B and group C (both P > 0.05). Tumor size, tumor number, PVTT location, and treatment modalities were independent prognostic factors (P < 0.05).
Conclusion
Postoperative TACE combined with PVC may benefit the survival of patients with HCC complicated by PVTT in the short-term (less than 60 months), but long-term efficacy is not yet certain and needs to be confirmed by further studies.
Similar content being viewed by others
References
Zhang JY, Dai M, Wang X, et al. A case-control study of hepatitis B and C virus infection as risk factors for hepatocellular carcinoma in Henan, China. Int J Epidemiol 1998;27:574–578
Chung YH, Song H, Song BC, et al. Combined therapy consisting of intraarterial cisplatin infusion and systemic interferon-a for hepatocellular carcinoma patients with major poral vein thrombosis or distant metastasis. Cancer 2000;88:1986–1991
Qiang L, Huikai L, Butt K, et al. Factors associated with disease survival after surgical resection in Chinese patients with Hepatocellular Carcinoma. World J Surg 2006;30:1–7
Momosaki S, Nakashima Y, Kojiro M, et al. HBsAg-negative hepatitis B virus infections in hepatitis C virus-associated hepatocellular carcinoma. J Viral Hepat 2005;12:325–329
Tokita H, Fukui H, Tanaka A, et al. Related articles, links risk factors for the development of hepatocellular carcinoma among patients with chronic hepatitis C who achieved a sustained virological response to interferon therapy. J Gastroenterol Hepatol 2005;20:752–758
Bismuth H, Chiche L, Adam R, et al. Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg 1993;218:145–151
Nagasue N, Uchida M, Makino Y, et al. Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology 1993;105:488–494
Tsai TJ, Chau GY, Lui WY, et al. Clinical significance of microscopic tumor venous invasion in patients with resectable hepatocellular carcinoma. Surgery 2000;127:603–608
Fujii T, Takayasu K, Muramatsu Y, et al. Hepatocellular carcinoma with portal tumor thrombus: analysis of factors determining prognosis. Jpn J Clin Oncol 1993;23:105–109
Llovet JM, Bustamante J, Castells A, et al. Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 1999;29:62–67
Fan J, Wu ZQ, Tang ZY, et al. Multimodality treatment in hepatocellular carcinoma patients with tumor thrombi in portal vein. World J Gastroenterol 2001;7:28–32
Cady B. Natural history of primary and secondary tumors of the liver. Semin Oncol 1983;10:127–134
Sakurai M, Okamura J, Kuroda C. Transcatheter chemo-embolization effective for treating hepatocellular carcinoma: a histopathologic study. Cancer 1984;54:387–392
Bruix J. Treatment of hepatocellular carcinoma. Hepatology 1997;25:259–262
Ohkubo T, Yamamoto J, Sugawara Y, et al. Surgical results for hepatocellular carcinoma with macroscopic portal vein tumor thrombosis. J Am Coll Surg 2000;191:657–660
Minagawa M, Makuuchi M, Takayama T, et al. Selection criteria for hepatectomy in patients with hepatocellular carcinoma and portal vein tumor thrombus. Ann Surg 2001;233:379–384
Friedman M. Primary hepatocellular cancer-present results and future prospects. Int J Radiat Oncol Biol Phys 1983;9:1841–1850
Iwamiya T, Sawada S, Ohta Y. Repeated arterial infusion chemotherapy for inoperable hepatocellular carcinoma using an implantable drug delivery system. Cancer Chemother Pharmacol 1994;33(Suppl):S134–S138
Une Y, Uchino J, Yasuhara M, et al. Intra-arterial infusion chemotherapy on unresectable hepatocellular carcinoma under occlusion of hepatic arterial flow. Clin Ther 1993;15:347–354
Toyoda H, Nakano S, Kumada T, Takeda I, Sugiyama K, Osada T, Kiriyama S, Suga T, Takahashi M. The efficacy of continuous local arterial infusion of 5-fluorouracil and cisplatin through an implanted reservoir for severe advanced hepatocellular carcinoma. Oncology 1995;52:295–299
Li Q, Hao XS, Zhang ZG, et al. Clinical value of portal vein chemotherapy in treatment of hepatocellular carcinoma with tumor thrombosis of main trunk of Portal vein. Chin J Hepatobiliary Surg 2002;7:420–421
Llovet JM, Beaugrand M. Hepatocellular carcinoma: present status and future prospects. J Hepatol 2003;38:S136–S149
Konishi M, Ryu M, Kinoshita T, et al. Surgical treatment of hepatocellular carcinoma with direct removal of the tumor thrombus in the main portal vein. Hepatogastroenterology 2001;48:1421–1424
Tazawa J, Maeda M, Sakai Y, et al. Radiation therapy in combination with transcatheter arterial chemoembolization for hepatocellular carcinoma with extensive portal vein involvement. J Gastroenterol Hepatol 2001;16:660–665
Yano Y, Sata M. Chemotherapy for hepatocellular carcinoma with portal hypertension due to tumor thrombus. J Clin Gastroenterol 2000;31:247–249
Inoue K, Nakamura T, Kinoshita T, et al. Volume reduction surgery for advanced hepatocellular carcinoma. J Cancer Res Clin Oncol 2004;130:362–366
Sangro B, Rios R, Bilbao I, et al. Efficacy and toxicity of intra-arterial cisplatin and etoposide for advanced hepatocellular carcinoma. Oncology 2002;62:293–298
Mathurin P, Raynard B, Dharancy S, et al. Meta-analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma. Aliment Pharmacol Ther 2003;17:1247–1261
Tanaka K, Shimada H, Togo S, et al. Use of transcatheter arterial infusion of anti-cancer agents with lipiodol to prevent recurrence of hepatocellular carcinoma after hepatic resection. Hepatogastroenterology 1999;46:1083–1088
Fukuda S, Okuda K, Imamura M, et al. Surgical resection combined with chemotherapy for advanced hepatocellular carcinoma with tumor thrombus: Report of 19 cases. Surgery 2002;131:300–310
Ishida H, Iwama T, Mishima Y. The significance of portal vein chemotherapy for liver micrometastases: an experimental study of a rat model. Surg Today 1994;24:900–905
Sargent DJ, Goldberg RM, Jacobson SD, et al. Portal vein chemotherapy for colorectal cancer: a meta-analysis of 4000 patients in 10 studies. J Natl Cancer Inst 1997;89:497–505
Labianca R, Fossati R, Zaniboni A, et al. Randomized trial of intraportal and/or systemic adjuvant chemotherapy in patients with colon carcinoma. J Natl Cancer Inst 2004;96:750–758
Fan J, Zhou J, Wu ZQ, et al. Efficacy of different treatment strategies for hepatocellular carcinoma with portal vein tumor thrombosis. World J Gastroenterol 2005;11:1215–1219
Konishi M, Ryu M, Kinoshita T, et al. Surgical treatment of hepatocellular carcinoma with direct removal of the tumor thrombus in the main portal vein. Hepatogastroenterology 2001;48:1421–1424
Fukuda S, Itamoto T, Nakahara H, et al. Clinicopathologic features and prognostic factors of resected solitary small-sized hepatocellular carcinoma. Hepatogastroenterology 2005;52:1163–1167
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Li, Q., Wang, J., Sun, Y. et al. Efficacy of Postoperative Transarterial Chemoembolization and Portal Vein Chemotherapy for Patients with Hepatocellular Carcinoma Complicated by Portal Vein Tumor Thrombosis—a Randomized Study. World J. Surg. 30, 2004–2011 (2006). https://doi.org/10.1007/s00268-006-0271-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-006-0271-6