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J Gastrointest Oncol. 2018 Dec;9(6):1074-1083. doi: 10.21037/jgo.2018.08.11.

Tailored treatment of patients with hepatocellular carcinoma with portal vein invasion: experience from a multidisciplinary hepatobiliary tumor program within a NCI comprehensive cancer center.

Author information

1
Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
2
Division of Gastroenterology, Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
3
Division of Biostatistics, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
4
Abdominal Transplant Division, Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
5
Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA.

Abstract

Background:

Hepatocellular carcinoma (HCC) with portal vein invasion (PVI) has a poor prognosis with limited treatment options. Intra-arterial brachytherapy (IAB) and transarterial chemoembolization (TACE) yield local control but risk accelerating liver dysfunction. The outcomes, survival, and safety of selective liver-directed treatment are reported.

Methods:

Thirty-seven consecutive patients with HCC and PVI treated between 2009 and 2015 were reviewed from a prospectively collected database. Univariate analysis, Kaplan-Meier plots using the log-rank method, and multivariate analyses were performed. Statistical significance was defined as P<0.05. Overall survival was reported in months (median; 95% CI).

Results:

Most patients (59%) had PVI identified at initial HCC diagnosis. The liver-directed therapy group (n=22) demonstrated a survival advantage versus the systemic/supportive care group (n=14) [23.6 (5.8, 30.9) vs. 6.0 (3.5, 8.8) months]. Patients indicated for liver directed therapy had unilateral liver involvement (100% vs. 43%, P<0.0001), lower median alkaline phosphatase (105.5 vs. 208.0, P=0.002), and lower mean Child-Turcotte-Pugh (CTP) score (5.9 vs. 7.2, P=0.04) and tolerated treatment without serious complications.

Conclusions:

In HCC patients presenting with PVI, liver-directed therapy was safely performed in patients with limited venous involvement and preserved liver function. Liver-directed therapy extended survival for these patients indicated for palliative chemotherapy by traditional guidelines.

KEYWORDS:

Hepatocellular carcinoma (HCC); portal vein invasion (PVI); portal vein tumor thrombus; transarterial chemoembolization (TACE); transarterial radioembolization

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

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