Survival outcomes of hepatic resection compared with transarterial chemoembolization or sorafenib for hepatocellular carcinoma with portal vein tumor thrombosis
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Background/Aims: Treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains controversial. We compared the outcomes of hepatic resection (HR), transarterial chemoembolization (TACE), and sorafenib therapy as treatments for HCC with PVTT. Methods: Patients diagnosed as HCC with PVTT between January 2000 and December 2011 who received treatment with sorafenib, HR, or TACE were included. Patients with main PVTT, superior mesenteric vein tumor thrombosis, or Child-Turcotte-Pugh (CTP) class C were excluded. The records of 172 patients were analyzed retrospectively. HR, TACE, and sorafenib treatment were performed is 40, 80, and 52 patients respectively. PVTT was classified as either involving the segmental branch (type I) or extending to involve the right or left portal vein (type II). Results: The median survival time was significantly longer in the HR group (19.9 months) than in the TACE and sorafenib groups (6.6 and 6.2 months, respectively; both P<0.001), and did not differ significantly between the latter two groups (P=0.698). Among patients with CTP class A, type I PVTT or unilobar-involved HCC, the median survival time was longer in the HR group than in the TACE and sorafenib groups (P=0.006). In univariate analyses, the initial treatment method, tumor size, PVTT type, involved lobe, CTP class, and presence of cirrhosis or ascites were correlated with overall survival. The significant prognostic factors for overall survival in Cox proportional-hazards regression analysis were initial treatment method (HR vs. TACE: hazard ratio=1.750, P=0.036; HR vs. sorafenib: hazard ratio=2.262, P=0.006), involved lobe (hazard ratio=1.705, P=0.008), PVTT type (hazard ratio=1.617, P=0.013), and CTP class (hazard ratio=1.712, P=0.012). Conclusions: Compared with TACE or sorafenib, HR may prolong the survival of patients with HCC in cases of CTP class A, type I PVTT or unilobar-involved HCC.
Abstract
Background/Aims: Treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains controversial. We compared the outcomes of hepatic resection (HR), transarterial chemoembolization (TACE), and sorafenib therapy as treatments for HCC with PVTT. Methods: Patients diagnosed as HCC with PVTT between January 2000 and December 2011 who received treatment with sorafenib, HR, or TACE were included. Patients with main PVTT, superior mesenteric vein tumor thrombosis, or Child-Turcotte-Pugh (CTP) class C were excluded. The records of 172 patients were analyzed retrospectively. HR, TACE, and sorafenib treatment were performed is 40, 80, and 52 patients respectively. PVTT was classified as either involving the segmental branch (type I) or extending to involve the right or left portal vein (type II). Results: The median survival time was significantly longer in the HR group (19.9 months) than in the TACE and sorafenib groups (6.6 and 6.2 months, respectively; both P<0.001), and did not differ significantly between the latter two groups (P=0.698). Among patients with CTP class A, type I PVTT or unilobar-involved HCC, the median survival time was longer in the HR group than in the TACE and sorafenib groups (P=0.006). In univariate analyses, the initial treatment method, tumor size, PVTT type, involved lobe, CTP class, and presence of cirrhosis or ascites were correlated with overall survival. The significant prognostic factors for overall survival in Cox proportional-hazards regression analysis were initial treatment method (HR vs. TACE: hazard ratio=1.750, P=0.036; HR vs. sorafenib: hazard ratio=2.262, P=0.006), involved lobe (hazard ratio=1.705, P=0.008), PVTT type (hazard ratio=1.617, P=0.013), and CTP class (hazard ratio=1.712, P=0.012). Conclusions: Compared with TACE or sorafenib, HR may prolong the survival of patients with HCC in cases of CTP class A, type I PVTT or unilobar-involved HCC.
참고문헌 (18)
- Yang JD, "Hepatocellular carcinoma: A global view", Nat Rev Gastroenterol Hepatol, 7, pp.448~458 (2010)
- Cheung TK, "Clinical features, biochemical parameters, and virological profiles of patients with hepatocellular carcinoma in Hong Kong", Aliment Pharmacol Ther, 24, pp.573~583 (2006)
- Llovet JM, "Hepatocellular carcinoma", Lancet, 362, pp.1907~1917 (2003)
- Llovet JM, "Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials", Hepatology, 29, pp.62~67 (1999)
- Villa E, "Natural history of inoperable hepatocellular carcinoma: estrogen receptors’ status in the tumor is the strongest prognostic factor for survival", Hepatology, 32, pp.233~238 (2000)
- Lai EC, "Hepatic resection for hepatocellular carcinoma. An audit of 343 patients", Ann Surg, 221, pp.291~298 (1995)
- Bruix J, "American Association for the Study of Liver Diseases(AASLD). Management of hepatocellular carcinoma: an update", Hepatology, 53, pp.1020~1022 (2011)
- European Association For The Study Of The Liver(EASL), "European Organisation For Research And Treatment Of Cancer(EORTC). EASLEORTC clinical practice guidelines: management of hepatocellular carcinoma", J Hepatol, 56, pp.908~943 (2012)
- Minagawa M, "Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus", World J Gastroenterol, 12, pp.7561~7567 (2006)
- Llovet JM, "Sorafenib in advanced hepatocellular carcinoma", N Engl J Med, 359, pp.378~390 (2008)
- Shi J, "Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus", Ann Surg Oncol, 17, pp.2073~2080 (2010)
- Lee HS, "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, pp.2087~2094 (1997)
- Luo J, "Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis: a prospective comparative study", Ann Surg Oncol, 18, pp.413~420 (2011)
- Takayasu K, "Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients", Gastroenterology, 131, pp.461~469 (2006)
- Kim KM, "Reappraisal of repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein invasion", J Gastroenterol Hepatol, 24, pp.806~814 (2009)
- Omata M, "Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma", Hepatol Int, 4, pp.439~474 (2010)
- Kudo M, "Management of hepatocellular carcinoma in Japan: Consensus- Based Clinical Practice Guidelines proposed by the Japan Society of Hepatology (JSH) 2010 updated version", Dig Dis, 29, pp.339~364 (2011)
- Peng ZW, "Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus", Cancer, 118, pp.4725~4736 (2012)