Factors Affecting Prognosis of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: Implications for Future Therapeutic Strategies.
- Author:
Sang Jun SUH
1
;
Hyung Joon YIM
;
Dong Won LEE
;
Jong Jin HYUN
;
Young Kul JUNG
;
Ji Hoon KIM
;
Yeon Seok SEO
;
Jong Eun YEON
;
Kwan Soo BYUN
;
Soon Ho UM
Author Information
- Publication Type:Original Article
- Keywords: Hepatocellular carcinoma; Portal vein; Thrombosis; Prognosis
- MeSH: Carcinoma, Hepatocellular*; Catheter Ablation; Drug Therapy; Fetal Proteins; Humans; Liver; Liver Neoplasms; Portal Vein*; Prognosis*; Radiotherapy; Retrospective Studies; Tertiary Care Centers; Thrombosis*; Tumor Burden
- From:Journal of Liver Cancer 2017;17(1):60-71
- CountryRepublic of Korea
- Language:Korean
- Abstract: BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) exhibits poor prognosis. The aim of this study is to evaluate factors associated with survival of HCC patients with PVTT to suggest better therapeutic options. METHODS: Patients with HCC which were newly diagnosed at three tertiary hospitals between January 2004 and December 2012, were reviewed retrospectively. Among them, Barcelona Clinic of Liver Cancer stage C patients with PVTT were identified. Factors affecting overall survival (OS) were analyzed and efficacies of the treatment modalities were compared. RESULTS: Four hundred sixty five patients with HCC and PVTT were included. Liver function, tumor burden, presence of extrahepatic tumor, alfa fetoprotein, and treatment modalities were significant factors associated with OS. Treatment outcomes were different according to the initial modalities. OS of the patients who received hepatic resection, radiofrequency ablation (RFA), transarterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC), sorafenib, systemic cytotoxic chemotherapy, radiation therapy (without combination), and supportive care were 27.8, 7.1, 6.7, 5.3, 2.5, 3.0, 1.8, and 0.9 months, respectively (P<0.001). Curative-intent treatments such as hepatic resection or RFA were superior to noncurativeintent treatments (P<0.001). TACE or HAIC was superior to sorafenib or systemic chemotherapy (P<0.001). Combining radiotherapy to TACE or HAIC did not provide additional benefit on OS (P=0.096). CONCLUSIONS: Treatment modalities as well as baseline factors significantly influenced on OS of HCC patients with PVTT. Whenever possible, curative intent treatments should be preferentially considered. If unable, locoregional therapy would be a better choice than systemic therapy in HCC patients with PVTT.
