Reappraisal of Portal Vein Tumor Thrombosis as a Prognostic Factor for Patients with Hepatocellular Carcinoma
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: This study aimed to assess whether hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) could have favorable prognoses with proper treatment under selective conditions. Methods: This retrospective, single-center study involved 1,168 patients diagnosed with HCC between January 2005 and December 2006, before the introduction of sorafenib. Overall survival (OS) was estimated using the Kaplan-Meier method, and the Cox proportional hazards model was used to identify and adjust the variables associated with OS. Results: In nodular-type HCC, the OS differed significantly according to the presence of PVTT (log-rank p<0.001), and the level of PVTT, not only its presence, was a major independent factor affecting OS. PVTT at the Vp1-3 branch was associated with significantly longer OS than was PVTT at the Vp4 level (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.04 to 3.21). In multivariate analysis, the OS was further stratified according to the PVTT level and tumor type, representing that nodular HCC without PVTT exhibited the best OS, whereas nodular HCC with Vp4 PVTT (adjusted HR, 2.59; 95% CI, 1.57 to 4.28) showed a poor prognosis similar to that of infiltrative HCC. The PVTT level was consistently correlated with OS in patients treated with transarterial chemoembolization. Nodular HCC without PVTT showed the best prognosis, while nodular HCC with Vp1-3 PVTT also exhibited a favorable OS, although inferior to that without PVTT (adjusted HR, 1.47, 95% CI, 0.92 to 2.36). Conclusions: Active treatment such as transarterial chemoembolization can be considered for selected PVTT cases. The level of PVTT and type of HCC were independent prognostic factors.
Abstract
Background/Aims: This study aimed to assess whether hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) could have favorable prognoses with proper treatment under selective conditions. Methods: This retrospective, single-center study involved 1,168 patients diagnosed with HCC between January 2005 and December 2006, before the introduction of sorafenib. Overall survival (OS) was estimated using the Kaplan-Meier method, and the Cox proportional hazards model was used to identify and adjust the variables associated with OS. Results: In nodular-type HCC, the OS differed significantly according to the presence of PVTT (log-rank p<0.001), and the level of PVTT, not only its presence, was a major independent factor affecting OS. PVTT at the Vp1-3 branch was associated with significantly longer OS than was PVTT at the Vp4 level (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.04 to 3.21). In multivariate analysis, the OS was further stratified according to the PVTT level and tumor type, representing that nodular HCC without PVTT exhibited the best OS, whereas nodular HCC with Vp4 PVTT (adjusted HR, 2.59; 95% CI, 1.57 to 4.28) showed a poor prognosis similar to that of infiltrative HCC. The PVTT level was consistently correlated with OS in patients treated with transarterial chemoembolization. Nodular HCC without PVTT showed the best prognosis, while nodular HCC with Vp1-3 PVTT also exhibited a favorable OS, although inferior to that without PVTT (adjusted HR, 1.47, 95% CI, 0.92 to 2.36). Conclusions: Active treatment such as transarterial chemoembolization can be considered for selected PVTT cases. The level of PVTT and type of HCC were independent prognostic factors.
참고문헌 (36)
- Global Burden of Disease Cancer Collaboration, "Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990to 2015 : a systematic analysis for the Global Burden of Disease Study", JAMA Oncol, 3, pp.524~548 (2017)
- Siegel RL, "Cancer statistics, 2016", CA Cancer J Clin, 66, pp.7~30 (2016)
- Giannini EG, "Prognosis of untreated hepatocellular carcinoma", Hepatology, 61, pp.184~190 (2015)
- Cabibbo G, "A meta-analysis of survival rates of untreated patients in randomized clinical trials of hepatocellular carcinoma", Hepatology, 51, pp.1274~1283 (2010)
- Tandon P, "Prognostic indicators in hepatocellular carcinoma : a systematic review of 72 studies", Liver Int, 29, pp.502~510 (2009)
- 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)
- 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)
- Ikai I, "Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey", Cancer, 101, pp.796~802 (2004)
- Park KW, "Survival analysis of 904patients with hepatocellular carcinoma in a hepatitis B virusendemic area", J Gastroenterol Hepatol, 23, pp.467~473 (2008)
- Shi J, "Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus", Ann Surg Oncol, 17, pp.2073~2080 (2010)
- Mazzaferro V, "Yttrium-90 radioembolization for intermediate-advanced hepatocellular carcinoma : a phase 2 study", Hepatology, 57, pp.1826~1837 (2013)
- Omata M, "Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma", Hepatol Int, 4, pp.439~474 (2010)
- Bruix J, "Management of hepatocellular carcinoma : an update", Hepatology, 53, pp.1020~1022 (2011)
- European Association for the Study of the Liver, "EASLEORTC clinical practice guidelines : management of hepatocellular carcinoma", J Hepatol, 56, pp.908~943 (2012)
- Benvegnù L, "Evidence for an association between the aetiology of cirrhosis and pattern of hepatocellular carcinoma development", Gut, 48, pp.110~115 (2001)
- Lopez RR Jr, "Comparison of transarterial chemoembolization in patients with unresectable, diffuse vs focal hepatocellular carcinoma", Arch Surg, 137, pp.653~658 (2002)
- Mehta N, "Factors associated with outcomes and response to therapy in patients with infiltrative hepatocellular carcinoma", Clin Gastroenterol Hepatol, 11, pp.572~578 (2013)
- Kneuertz PJ, "Diffuse infiltrative hepatocellular carcinoma : assessment of presentation, treatment, and outcomes", Ann Surg Oncol, 19, pp.2897~2907 (2012)
- Kojiro M, "Histopathology of liver cancers", Best Pract Res Clin Gastroenterol, 19, pp.39~62 (2005)
- Reynolds AR, "Infiltrative hepatocellular carcinoma : what radiologists need to know", Radiographics, 35, pp.371~386 (2015)
- Kanematsu M, "Hepatocellular carcinoma of diffuse type : MR imaging findings and clinical manifestations", J Magn Reson Imaging, 18, pp.189~195 (2003)
- Lee WK, "Imaging assessment of congenital and acquired abnormalities of the portal venous system", Radiographics, 31, pp.905~926 (2011)
- Ikai I, "Report of the 17th Nationwide Follow-up Survey of Primary Liver Cancer in Japan", Hepatol Res, 37, pp.676~691 (2007)
- Marrero JA, "Prognosis of hepatocellular carcinoma : comparison of 7 staging systems in an American cohort", Hepatology, 41, pp.707~716 (2005)
- Cillo U, "Prospective validation of the Barcelona Clinic Liver Cancer staging system", J Hepatol, 44, pp.723~731 (2006)
- Guglielmi A, "Comparison of seven staging systems in cirrhotic patients with hepatocellular carcinoma in a cohort of patients who underwent radiofrequency ablation with complete response", Am J Gastroenterol, 103, pp.597~604 (2008)
- Forner A, "Hepatocellular carcinoma", Lancet, 379, pp.1245~1255 (2012)
- Yau T, "Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma", Gastroenterology, 146, pp.1691~1700 (2014)
- Hatano E, "Significance of hepatic resection and adjuvant hepatic arterial infusion chemotherapy for hepatocellular carcinoma with portal vein tumor thrombus in the first branch of portal vein and the main portal trunk : a project study for hepatic surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery", J Hepatobiliary Pancreat Sci, 25, pp.395~402 (2018)
- Kokudo T, "Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion", J Hepatol, 65, pp.938~943 (2016)
- Cerrito L, "Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis : Beyond the known frontiers", World J Gastroenterol, 25, pp.4360~4382 (2019)
- Ahn YE, "Comparison of sorafenib versus hepatic arterial infusion chemotherapy-based treatment for advanced hepatocellular carcinoma with portal vein tumor thrombosis", Gut Liver, 15, pp.284~294 (2021)
- Silva JP, "Transarterial chemoembolization in hepatocellular carcinoma with portal vein tumor thrombosis : a systematic review and meta-analysis", HPB(Oxford), 19, pp.659~666 (2017)
- Choi JY, "CT and MR imaging diagnosis and staging of hepatocellular carcinoma : part I. Development, growth, and spread : key pathologic and imaging aspects", Radiology, 272, pp.635~654 (2014)
- Lee YJ, "How should we assign large infiltrative hepatocellular carcinomas for staging?", Cancers(Basel), 12, pp.2589~ (2020)