Prognostic factors of hepatocellular carcinoma patients with portal vein tumor thrombosis treated with transcatheter arterial chemoembolization

2017 ◽  
Vol 13 (5) ◽  
pp. e331-e341 ◽  
Author(s):  
Hongyuan Liang ◽  
Peng Cui ◽  
Qiyong Guo ◽  
Xiaonan Mao ◽  
Feng Wen ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Prognostic Factors ◽  
Portal Vein ◽  
Transcatheter Arterial Chemoembolization ◽  
Portal Vein Tumor Thrombosis ◽  
Tumor Thrombosis ◽  
Arterial Chemoembolization

scholarly journals Diffuse Infiltrative Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis Completely Cured by Transcatheter Arterial Chemoembolization: Case Report with 8-Year Follow-Up

2016 ◽  
Vol 10 (3) ◽  
pp. 623-628 ◽  
Author(s):  
Suk Bae Kim
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Transcatheter Arterial Chemoembolization ◽  
Treatment Options ◽  
Common Type ◽  
Portal Vein Tumor Thrombosis ◽  
Diffuse Type ◽  
Tumor Thrombosis ◽  
Arterial Chemoembolization

Hepatocellular carcinoma (HCC) is the most common type of liver cancer and its treatment options are determined by shape, liver function, loci, and stages of cancer. Diffuse type of infiltrative HCC accompanied by portal vein tumor thrombosis (PVTT) has the poorest prognosis among other HCCs and there are no other prominent treatment options than systemic chemotherapy. In this study, we report a case of a 56-year-old man with diffuse infiltrative HCC accompanied by PVTT who achieved complete remission for 8 years after receiving conventional transcatheter arterial chemoembolization using adriamycin and gelfoam.

scholarly journals Safety and efficacy of endovascular implantation of a portal vein stent combined with iodine-125 seed-strips followed by transcatheter arterial chemoembolization with sorafenib for the treatment of hepatocellular carcinoma with portal vein tumor thrombosis

2020 ◽  
Vol 93 (1112) ◽  
pp. 20190279
Author(s):  
Shuangxi Li ◽  
Lei Li ◽  
Baohua Li ◽  
Wenhui Wang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Function ◽  
Portal Vein ◽  
Transcatheter Arterial Chemoembolization ◽  
Portal Vein Tumor Thrombosis ◽  
Technical Success ◽  
Safety And Efficacy ◽  
Tumor Thrombosis ◽  
Baseline Values ◽  
Arterial Chemoembolization

Objective: To assess the safety and efficacy of endovascular implantation of a portal vein stent combined with iodine-125 seed-strips followed by transcatheter arterial chemoembolization with sorafenib (PVS-125I-TACE-S) for the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Methods: Between January 2015 and July 2017, 18 patients with PVTT caused by HCC that were treated with PVS-125I-TACE-S were reviewed. The technical success, complications, changes in liver function from baseline values due to subsequent endovascular implantation of a portal vein stent combined with iodine-125 seed-strips (PVS-125I), time-to-tumor progression (TTP) and overall survival (OS) were observed. Results: The technical success rate was 100%. Adverse events (AEs) were managed successfully, with no occurrence of procedure-related deaths. Liver function test values after PVS-125I were not significantly different than baseline values (P＞0.05). The median TTP was 7.0 months (range: 4.2–9.9 months). In Vp3 PVTT, the TTP was 9.7 months (range: 8.8–10.5 months), and in Vp4 PVTT, the TTP was 4.2 months (range: 2.8–5.6 months). The median OS was 10.0 months (range: 7.0–13.1 months). In Vp3 PVTT, OS was 11.9 months (range: 9.2–14.5 months), and in Vp4 PVTT, OS was 7.2 months (range: 3.8–10.7 months). Conclusions: PVS-125I-TACE-S is safe for patients with HCC with PVTT and may extend the TTP and survival of patients with Vp4 PVTT. Advances in knowledge: PVS implantation promptly restored flow in the obstructed portal vein, which can reduce the risk of hepatic failure and upper gastrointestinal bleeding. Implantation of iodine-125 seed-strips may directly expose the portal tumor thrombus to radiation and kill cancer cells. Their combined use with TACE-S has a strong scientific rationale.

scholarly journals Transarterial Chemoembolization for the Treatment of Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: Prognostic Factors in a Single-Center Study of 188 Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Lei Liu ◽  
Cheng Zhang ◽  
Yan Zhao ◽  
Xingshun Qi ◽  
Hui Chen ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Prognostic Factors ◽  
Portal Vein ◽  
Transarterial Chemoembolization ◽  
Cox Regression ◽  
Advanced Hepatocellular Carcinoma ◽  
Portal Vein Tumor Thrombosis ◽  
Cox Regression Analysis ◽  
Tumor Thrombosis ◽  
Pugh Class

Transarterial chemoembolization (TACE) could achieve a better survival benefit than conservative treatment for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). In this retrospective study, all HCC patients with Child-Pugh score <7 and PVTT who were consecutively admitted to our center between January 2006 and June 2012 and underwent TACE were enrolled. The efficacy and safety of TACE were analyzed. Prognostic factors were determined by Cox regression analysis. Of the 188 patients included, 89% had hepatitis B virus infection, 100% were at Barcelona Clinic Liver Cancer stage C, and 81% (n=152) and 19% (n=36) were at Child-Pugh classes A and B, respectively. The incidence of procedure-related complications was 88%. No procedure-related death was found. The median overall survival was 6.1 months. Type of PVTT (hazard ratio [HR] = 2.806), number of tumor lesions (HR = 2.288), Child-Pugh class (HR = 2.981), and presence of metastasis (HR = 1.909) were the independent predictors of survival. In conclusion, TACE could be selectively used for the treatment of advanced HCC with PVTT. But a high rate of postoperative adverse events should not be undermined in spite of no procedure-related death. Preoperative type of PVTT, number of tumor lesions, Child-Pugh class, and metastasis could predict the prognosis of these patients.

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

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.

scholarly journals Improving outcomes of liver resection for hepatocellular carcinoma associated with portal vein tumor thrombosis over the evolving eras of treatment

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yu-Chao Wang ◽  
Jin-Chiao Lee ◽  
Tsung-Han Wu ◽  
Chih-Hsien Cheng ◽  
Chen-Fang Lee ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Liver Resection ◽  
Portal Vein ◽  
Survival Rates ◽  
Portal Vein Tumor Thrombosis ◽  
Tumor Thrombosis ◽  
Evolutionary Changes ◽  
Hcc Recurrence

Abstract Background The outcomes and management of hepatocellular carcinoma (HCC) have undergone several evolutionary changes. This study aimed to analyze the outcomes of patients who had undergone liver resection for HCC with portal vein tumor thrombosis (PVTT) in terms of the evolving era of treatment. Materials and methods A retrospective analysis of 157 patients who had undergone liver resection for HCC associated with PVTT was performed. The outcomes and prognostic factors related to different eras were further examined. Results Overall, 129 (82.1%) patients encountered HCC recurrence after liver resection, and the median time of recurrence was 4.1 months. Maximum tumor size ≥ 5 cm and PVTT in the main portal trunk were identified as the major prognostic factors influencing HCC recurrence after liver resection. Although the recurrence-free survival had no statistical difference between the two eras, the overall survival of patients in the second era was significantly better than that of the patients in the first era (p = 0.004). The 1-, 2-, and 3-year overall survival rates of patients in the second era were 60.0%, 45.7%, and 35.8%, respectively, with a median survival time of 19.6 months. Conclusion The outcomes of HCC associated with PVTT remain unsatisfactory because of a high incidence of tumor recurrence even after curative resection. Although the management and outcomes of patients with HCC and PVTT have greatly improved over the years, surgical resection remains an option to achieve a potential cure of HCC in well-selected patients.

scholarly journals Body Composition Changes in Hepatocellular Carcinoma: Prediction of Survival to Transcatheter Arterial Chemoembolization in Combination With Clinical Prognostic Factors

2021 ◽  
Vol 28 ◽  
pp. 107327482110384
Author(s):  
Xiaomin Zheng ◽  
Feng Cao ◽  
Liting Qian ◽  
Jiangning Dong
Keyword(s):  
Hepatocellular Carcinoma ◽  
Body Composition ◽  
Prognostic Factors ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Transcatheter Arterial Chemoembolization ◽  
Vein Thrombosis ◽  
Prediction Of Survival ◽  
Composition Changes ◽  
Arterial Chemoembolization

Treatment-related toxicities and decreased levels of patient performance during cancer therapy might contribute to body composition changes (BCC) and thereby impact outcomes. This study investigated the association between BCC during transcatheter arterial chemoembolization (TACE) and outcome in patients with hepatocellular carcinoma (HCC), and developed a nomogram for predicting survival in combination with clinical prognostic factors (CPF). Pretreatment and posttreatment computed tomography (CT) images of 75 patients with HCC who were treated between 2015 and 2018 were analyzed. The bone mineral density (BMD), cross-sectional area of paraspinal muscles (CSAmuscle), subcutaneous fat area (SFA), and visceral fat area (VFA) were measured from two sets of CT images. Count the changes in body composition during treatment and sort out the CPF of patients. Using cox regression models, CSAmuscle change, SFA change, VFA change, child-push class, and portal vein thrombosis were independent prognostic factors for overall survival (OS) (HR=5.932, 2.384, 3.140, 1.744, 1.794, respectively. P < 0.05). Receiver operating characteristic curves (ROCs) showed the prediction model combination of BCC and CPF exhibited the highest predictive performance (AUC=0.937). Independent prognostic factors were all contained into the prognostic nomogram, the concordance index (C-index) of prognostic nomogram was 0.787 (95% CI, 0.675−0.887). Decision curve analysis (DCA) demonstrated that the prognostic nomogram was clinically useful. Nomogram-based risk classification systems were also constructed to facilitate risk stratification in HCC for optimization of clinical management. In conclusion, we identified CSAmuscle change, SFA change, VFA change, Child-Pugh class, and portal vein thrombosis were independent prognostic factors for HCC. The prognostic nomogram with a combination of BCC and CPF that can be applied in the individualized prediction of survival in patients with HCC after TACE.

Sign in / Sign up

Export Citation Format

Share Document