Efficacy comparison of optimal treatments for hepatocellular carcinoma patients with portal vein tumor thrombus

• Published in: Annals of hepatology Vol. 27; no. 1; p. 100552
• Main Authors: Zhang, Yu, Wu, Jun-Li, Li, Le-Qun
• Format: Journal Article
• Language: English
• Published: Mexico Elsevier España, S.L.U 01.01.2022; Elsevier
• Subjects: Antineoplastic Agents - administration & dosage; Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic - methods; Female; Follow-Up Studies; Hepatectomy - methods; Humans; Infusions, Intra-Arterial; Liver Neoplasms - complications; Liver Neoplasms - diagnosis; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Liver resection; Male; Middle Aged; Overall survival; Portal Vein; Retrospective Studies; Sorafenib; Sorafenib - administration & dosage; Time Factors; Transarterial chemoembolization; Venous Thrombosis - diagnosis; Venous Thrombosis - etiology; Venous Thrombosis - therapy; Liver resection; PVTT; OS; MRI; LR; BCLC; TACE; HCC; AFP; Sorafenib; Transarterial chemoembolization; HCV; Overall survival; HBV
• ISSN: 1665-2681; 2659-5982
• DOI: 10.1016/j.aohep.2021.100552

Optimal treatment of hepatocellular carcinoma (HCC) involving portal vein tumor thrombus (PVTT) remains controversial. A total of 627 HCC patients with PVTT after initial treatment with one of the following at Affiliated Tumor Hospital of Guangxi Medical University: liver resection (LR, n = 225), transarterial chemoembolization (TACE, n = 298) or sorafenib (n = 104) were recruited and randomly divided into the training cohort (n = 314) and internal validation cohort (n = 313). Survival analysis were repeated after stratifying patients by Cheng PVTT type. Resection led to significantly higher OS than the other two treatments among patients with type I or II PVTT. TACE worked significantly better than the other two treatments for patients with type III. All three treatments were associated with similar OS among patients with type IV. These findings were supported by the internal validation cohort. Our results suggest that the optimal treatment for HCC involving PVTT depends on the type of PVTT. LR may be more appropriate for type I or II PVTT; TACE, for type III Sorafenib may be more appropriate than invasive treatments for patients with type IV PVTT.