A prognostic score model for predicting the survival benefits of patients undergoing sorafenib plus transarterial chemoembolization for hepatocellular carcinoma with portal vein invasion

The purpose of this study was to investigate the efficacy and safety of drug-eluting beads transarterial chemoembolization (DEB-TACE) treatment in Chinese hepatocellular carcinoma (HCC) patients and the prognostic factors for treatment response as well as survival. A total of 275 HCC patients were included in this prospective study. Treatment response was assessed by modified Response Evaluation Criteria in Solid Tumors (mRECIST), and progression-free survival (PFS) as well as overall survival (OS) were determined. Liver function and adverse events (AEs) were assessed before and after DEB-TACE operation. Complete response (CR), partial response (PR), and objective response rate (ORR) were 22.9%, 60.7%, and 83.6%, respectively. The mean PFS was 362 (95% CI: 34.9‐375) days, the 6-month PFS rate was 89.4 ± 2.1%, while the mean OS was 380 (95% CI: 370‐389) days, and the 6-month OS rate was 94.4 ± 1.7%. Multivariate logistic regression revealed that portal vein invasion (p = 0.011) was an independent predictor of worse clinical response. Portal vein invasion (p = 0.040), previous cTACE treatment (p = 0.030), as well as abnormal serum creatinine level (BCr) (p = 0.017) were independent factors that predicted worse ORR. In terms of survival, higher Barcelona Clinic Liver Cancer (BCLC) stage (p = 0.029) predicted for worse PFS, and abnormal albumin (ALB) (p = 0.011) and total serum bilirubin (TBIL) (p = 0.009) predicted for worse OS. The number of patients with abnormal albumin, total protein (TP), TBIL, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were augmented at 1 week posttreatment and were similar at 1‐3 months compared with baseline. The most common AEs were pain, fever, nausea, and vomiting, and no severe AEs were observed in this study. DEB-TACE was effective and tolerable in treating Chinese HCC patients, and portal vein invasion, previous cTACE treatment, abnormal BCr, ALB, and TBIL appear to be important factors that predict worse clinical outcome.

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Development of a prognostic score to predict response to Yttrium-90 radioembolization for hepatocellular carcinoma with portal vein invasion

Journal of Hepatology ◽

10.1016/j.jhep.2017.12.026 ◽

2018 ◽

Vol 68 (4) ◽

pp. 724-732 ◽

Cited By ~ 43

Author(s):

Carlo Spreafico ◽

Carlo Sposito ◽

Marta Vaiani ◽

Tommaso Cascella ◽

Sherrie Bhoori ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Portal Vein ◽

Prognostic Score ◽

Portal Vein Invasion ◽

Yttrium 90

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Abstract No. 38: Transarterial chemoembolization for advanced hepatocellular carcinoma with portal vein invasion: safety, efficacy and prognostic factors

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2011.12.073 ◽

2012 ◽

Vol 23 (3) ◽

pp. S19

Author(s):

M. Chern ◽

V.P. Chuang ◽

C. Liang ◽

Z.H. Lin

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factors ◽

Portal Vein ◽

Transarterial Chemoembolization ◽

Advanced Hepatocellular Carcinoma ◽

Portal Vein Invasion

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Comparison of surgical resection versus transarterial chemoembolization with additional radiation therapy in patients with hepatocellular carcinoma with portal vein invasion

Clinical and Molecular Hepatology ◽

10.3350/cmh.2018.1001 ◽

2018 ◽

Vol 24 (2) ◽

pp. 135-136

Author(s):

Jin Wook Chung

Keyword(s):

Hepatocellular Carcinoma ◽

Radiation Therapy ◽

Portal Vein ◽

Surgical Resection ◽

Transarterial Chemoembolization ◽

Portal Vein Invasion ◽

Additional Radiation

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Comparison of surgical resection versus transarterial chemoembolization with additional radiation therapy in patients with hepatocellular carcinoma with portal vein invasion

Clinical and Molecular Hepatology ◽

10.3350/cmh.2017.0041 ◽

2018 ◽

Vol 24 (2) ◽

pp. 144-150 ◽

Cited By ~ 7

Author(s):

Danbi Lee ◽

Han Chu Lee ◽

Jihyun An ◽

Ju Hyun Shim ◽

Kang Mo Kim ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Radiation Therapy ◽

Portal Vein ◽

Surgical Resection ◽

Transarterial Chemoembolization ◽

Portal Vein Invasion ◽

Additional Radiation

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Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: A Tertiary Care Center Experience

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1734367 ◽

2021 ◽

Author(s):

Yashwant Patidar ◽

Amar Mukund ◽

Shiv K. Sarin ◽

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factors ◽

Liver Function ◽

Portal Vein ◽

Transarterial Chemoembolization ◽

Tumor Thrombus ◽

Portal Vein Tumor Thrombosis ◽

Main Portal Vein ◽

Portal Vein Invasion ◽

Tumor Thrombosis

Abstract Background Portal vein tumor thrombosis (PVTT) is a common complication of hepatocellular carcinoma (HCC) occurring in 30 to 40% of cases. The presence of PVTT in HCC is regarded as an advanced disease that confers poor prognosis and survival. Transarterial chemoembolization (TACE) has traditionally been considered to be contraindicated in cases of PVTT, due to the risk of hepatic infarction, and further deteriorate liver function. We evaluated safety, technical efficacy, and outcomes of TACE in HCC with PVTT. Methods From search results of the hospital database, out of 652 patients who underwent TACE for HCC, 73 patients of HCC with PVTT were retrospectively evaluated. Post-TACE tumor response by computed tomography (CT)/magnetic resonance imaging (MRI) imaging as per modified response evaluation criteria in solid tumors (mRECIST) criteria, if any occurrence of acute hepatic failure was assessed. Prognostic factors influencing survival were also determined. Results In our study population, the mean age of the patients was 58 years. The 12- and 24-month survival rates were 59 and 14%, respectively, with an overall median survival of 12.3 months. A total of 58.9% patients had branch portal vein tumor thrombus and 41.1% had tumor thrombus in the main portal vein. We did not encounter any mortality or acute liver failure following TACE in a 30-day period. Both univariate and multivariate analysis revealed Child–Pugh score (p = 0.01) and the extent of tumoral thrombus (p 0.004) as a significant prognostic factor. Patients with branch PVTT, no ascites, and Child–Pugh A had better survival than those having main portal vein tumor thrombus, ascites, and Child–Pugh B. Conclusion Our study concluded that TACE can achieve good disease control and improved survival in HCC with portal vein invasion despite being considered as a relative contraindication. Technical expertise, selection of patients, such as superselective catheterization and preserved liver function, are the key factors for a safe therapeutic procedure. Child–Pugh score and extent of portal vein invasion were the significant prognostic factors determining survival.

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