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Efficacy of Postoperative Transarterial Chemoembolization and Portal Vein Chemotherapy for Patients with Hepatocellular Carcinoma Complicated by Portal Vein Tumor Thrombosis—a Randomized Study

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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.

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References

  1. 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

    Article  PubMed  CAS  Google Scholar 

  2. 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

    Article  PubMed  CAS  Google Scholar 

  3. 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

    Article  Google Scholar 

  4. 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

    Article  PubMed  CAS  Google Scholar 

  5. 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

    Article  PubMed  CAS  Google Scholar 

  6. Bismuth H, Chiche L, Adam R, et al. Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg 1993;218:145–151

    PubMed  CAS  Google Scholar 

  7. 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

    PubMed  CAS  Google Scholar 

  8. 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

    Article  PubMed  CAS  Google Scholar 

  9. 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

    PubMed  CAS  Google Scholar 

  10. 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

    Article  PubMed  CAS  Google Scholar 

  11. 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

    PubMed  CAS  Google Scholar 

  12. Cady B. Natural history of primary and secondary tumors of the liver. Semin Oncol 1983;10:127–134

    PubMed  CAS  Google Scholar 

  13. Sakurai M, Okamura J, Kuroda C. Transcatheter chemo-embolization effective for treating hepatocellular carcinoma: a histopathologic study. Cancer 1984;54:387–392

    Article  PubMed  CAS  Google Scholar 

  14. Bruix J. Treatment of hepatocellular carcinoma. Hepatology 1997;25:259–262

    Article  PubMed  CAS  Google Scholar 

  15. 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

    Article  PubMed  CAS  Google Scholar 

  16. 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

    Article  PubMed  CAS  Google Scholar 

  17. Friedman M. Primary hepatocellular cancer-present results and future prospects. Int J Radiat Oncol Biol Phys 1983;9:1841–1850

    PubMed  CAS  Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

  19. 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

    PubMed  CAS  Google Scholar 

  20. 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

    Article  PubMed  CAS  Google Scholar 

  21. 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

    Google Scholar 

  22. Llovet JM, Beaugrand M. Hepatocellular carcinoma: present status and future prospects. J Hepatol 2003;38:S136–S149

    Article  PubMed  Google Scholar 

  23. 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

    PubMed  CAS  Google Scholar 

  24. 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

    Article  PubMed  CAS  Google Scholar 

  25. Yano Y, Sata M. Chemotherapy for hepatocellular carcinoma with portal hypertension due to tumor thrombus. J Clin Gastroenterol 2000;31:247–249

    Article  PubMed  Google Scholar 

  26. Inoue K, Nakamura T, Kinoshita T, et al. Volume reduction surgery for advanced hepatocellular carcinoma. J Cancer Res Clin Oncol 2004;130:362–366

    Article  PubMed  Google Scholar 

  27. 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

    Article  PubMed  CAS  Google Scholar 

  28. 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

    Article  PubMed  CAS  Google Scholar 

  29. 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

    PubMed  CAS  Google Scholar 

  30. 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

    Article  PubMed  Google Scholar 

  31. 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

    Article  PubMed  CAS  Google Scholar 

  32. 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

    Article  Google Scholar 

  33. 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

    Article  PubMed  CAS  Google Scholar 

  34. 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

    PubMed  Google Scholar 

  35. 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

    PubMed  CAS  Google Scholar 

  36. 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

    PubMed  Google Scholar 

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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

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