scholarly journals Transarterial Chemoembolization Combined with Lenvatinib plus PD-1 Inhibitor for Advanced Hepatocellular Carcinoma: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Mingyue Cai ◽  
Wensou Huang ◽  
Jingjun Huang ◽  
Wenbo Shi ◽  
Yongjian Guo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Extrahepatic Metastasis ◽  
Advanced Hepatocellular Carcinoma ◽  
Main Portal Vein ◽  
Portal Vein Invasion ◽  
Advanced Hcc ◽  
Tumor Number ◽  
Independent Risk Factors

Abstract Purpose To investigate the efficacy and safety of transarterial chemoembolization (TACE) combined with lenvatinib plus PD-1 inhibitor (TACE-L-P) versus TACE combined with lenvatinib (TACE-L) for patients with advanced hepatocellular carcinoma (HCC).Methods Data of advanced HCC patients treated with TACE-L-P or TACE-L from January 2019 to December 2020 were retrospectively analyzed. The differences in overall survival (OS), progression-free survival (PFS), tumor responses (based on modified Response Evaluation Criteria in Solid Tumors) and adverse events (AEs) were compared between the two groups. Potential factors affecting OS and PFS were determined.Results A total of 81 patients were included in this study (41 received TACE-L-P and 40 received TACE-L). The patients in TACE-L-P group had prolonged OS (median, 16.9 vs. 12.1 months, p=0.009), longer PFS (median, 7.3 vs. 4.0 months, p=0.002) and higher objective response rate (56.1% vs. 32.5%, p=0.033) and disease control rate (85.4% vs. 62.5%, p=0.019) than those in TACE-L group. Multivariate analyses revealed that the treatment option of TACE-L, main portal vein invasion and extrahepatic metastasis were the independent risk factors for OS, while TACE-L and extrahepatic metastasis were the independent risk factors for PFS. In subgroup analyses, a superior survival benefit was achieved with TACE-L-P in patients with extrahepatic metastasis or tumor number >3 but not in those with main portal vein invasion. The incidence and severity of AEs in TACE-L-P group were comparable to those in TACE-L group (any grade, 92.7% vs. 95.0%, p=1.000; grade 3, 36.6% vs. 32.5%, p=0.699).Conclusion TACE-L-P significantly improved survival over TACE-L with an acceptable safety profile in advanced HCC patients, especially those with extrahepatic metastasis or tumor number >3 but without main portal vein invasion.

scholarly journals Controlling Major Portal Vein Invasion Progression during Lenvatinib Treatment by Carbon-Ion Radiotherapy in Patients with Advanced Hepatocellular Carcinoma

2021 ◽  
pp. 1103-1110
Author(s):  
Ryoi Yoshida ◽  
Keisuke Koroki ◽  
Hirokazu Makishima ◽  
Sadahisa Ogasawara ◽  
Takamasa Ishino ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Systemic Therapy ◽  
Standard Treatment ◽  
Carbon Ion Radiotherapy ◽  
Advanced Hepatocellular Carcinoma ◽  
Portal Vein Invasion ◽  
Main Trunk ◽  
Advanced Hcc ◽  
Carbon Ion

Macrovascular invasion (MVI), including portal vein tumor thrombosis (PVTT), is strongly associated with poor prognosis in patients with hepatocellular carcinoma (HCC). While recommended standard treatment for patients with advanced HCC is systemic therapy, various treatment approaches, including resection, transarterial chemoembolization, and radiation, have been empirically suggested to improve prognosis by eliminating or controlling MVI. Herein, we report our experience of a case with advanced HCC where MVI was controlled by carbon-ion radiotherapy (CIRT) while on systemic therapy, resulting in a prolonged survival. A female patient with HCC in her early 60s had multiple intrahepatic lesions (maximum 60 mm in diameter) with PVTT. The PVTT of this patient had reached the main trunk of the portal vein despite the use of lenvatinib. The other intrahepatic lesions of the patient, except PVTT, had been controlled by lenvatinib. Therefore, hoping to control PVTT, we attempted CIRT. The patient resumed lenvatinib therapy after the irradiation. During lenvatinib re-treatment, no evident progression of PVTT was observed in the patient.

scholarly journals Successful Conversion Surgery for Massive Hepatocellular Carcinoma with Tumor Thrombus in Main Portal Vein after Treatment with Lenvatinib Combined with Toripalimab: A Case Report

2021 ◽  
Author(s):  
JingZhong OuYang ◽  
Yanzhao Zhou ◽  
Zhengzheng Wang ◽  
Qingjun Li ◽  
Jinxue Zhou
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Tumor Thrombus ◽  
Inflammatory Cells ◽  
Complete Response ◽  
Advanced Hepatocellular Carcinoma ◽  
Main Portal Vein ◽  
Advanced Hcc ◽  
Dismal Prognosis ◽  
The Right

Abstract Background:Advanced hepatocellular carcinoma (HCC) with Portal vein invasion has an extremely dismal prognosis. We report a rare case of advanced HCC with portal vein tumor thrombus (PVTT). First, Lenvatinib(Len) combined with Toripalimab(Tor) was treated. The patient was successfully treated with radical surgical resection after the tumor thrombus shrank. Postoperative pathology showed complete response (CR).Case presentation:A 52-year-old male patient had a massive liver cancer in his right liver, and the tumor thrombus grew to the main portal vein. He passed 4 cycles of Len combined with Tor, the tumor shrank rapidly, the level of tumor markers dropped rapidly, The tumor thrombus was successfully confined from the main portal vein to the right branch of the portal vein. Therefore, the patient underwent a right hepatectomy and successfully removed a complete PVTT. Histopathological results showed that the primary tumor and tumor thrombus were only infiltrated by inflammatory cells, and there were no viable tumor cells.Conclusions:Len combined with Tor can be used as a preoperative neoadjuvant regimen for the treatment of advanced HCC with massive macrovascular invasion.

Risk factors of hospital mortality after initial hepatic resection among patients with primary hepatocellular carcinoma.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 352-352
Author(s):  
Hong-Gui Qin ◽  
Jian-Hong Zhong ◽  
Yan-Yan Wang ◽  
Shi-Dong Lu ◽  
Bang-De Xiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Multivariate Analysis ◽  
Portal Hypertension ◽  
Major Hepatectomy ◽  
Postoperative Mortality ◽  
Primary Hepatocellular Carcinoma ◽  
Model Parameters ◽  
Tumor Number ◽  
Independent Risk Factors

352 Background: Hepatectomy is widely used to treat patients with hepatocellular carcinoma (HCC), even those with intermediate and advanced disease. Despite its well-demonstrated clinical efficacy in many patients, postoperative mortality is an inevitable problem. This study aims to investigate the risk factors of mortality after hepatectomy. Methods: A consecutive sample of 1518 patients with HCC who underwent initial hepatectomy from January 1, 2004 to October 31, 2013 were retrospective analyzed. Multivariate analysis to identify independent risk factors of postoperative mortality was carried out using the Cox proportional hazards model. Parameters for multivariate analyses included age, gender, tumor size, tumor number, preoperative serum albumin, alanine aminotransferase, total bilirubin, α-fetoprotein, prothrombin time, tumor capsule, macrovascular invasion, portal hypertension, diabetes mellitus, ascites, major hepatectomy, surgical time, blood loss, blood transfusion, and clamping portal hepatis time. Results: A total of 18 (1.19%) and 45 (2.96%) patients died within 30 and 90 days after hepatectomy, respectively. Multivariate analysis revealed that tumor number ( ≥ 4), macrovascular invasion, and major hepatectomy were independent risk factors of 30 and 90 days mortality, while portal hypertension was also an independent risk factor of 90 days mortality. Conclusions: Among HCC patients with tumor number equal or more than four, macrovascular invasion, portal hypertension, or underwent major hepatectomy, intensive postoperative care management are in particular.

scholarly journals Development of a Prognostic Scoring System for Hepatocellular Carcinoma Patients With Main Portal Vein Tumor Thrombus Undergoing Conventional Transarterial Chemoembolization: An Analysis of 173 Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Jing-huan Li ◽  
Xin Yin ◽  
Wen-shuai Fan ◽  
Lan Zhang ◽  
Rong-xin Chen ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Tumor Thrombus ◽  
Portal Vein Tumor Thrombus ◽  
Ratio Test ◽  
Tumor Diameter ◽  
Main Portal Vein ◽  
Cox Regression Analysis ◽  
Tumor Number ◽  
Prognostic Stratification

BackgroundPatients with hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (mPVTT) have poor prognosis. Promising systemic therapies, such as target therapies, have limited benefits. The purpose of this study is to retrospectively evaluate the benefits of conventional TACE (c-TACE) and to establish a prognostic stratification of HCC patients with mPVTT.MethodsThis is a single center retrospective study conducted over 5 years (duration of performing c-TACE), on consecutive HCC patients with mPVTT receiving c-TACE. Univariable and multivariable analysis were used to explore factors independently associated with overall survival (OS). Based on Cox-regression analysis, prognostic models were developed and internally validated by bootstrap methods. Discrimination and performance were measured by Akaike information criterion, concordance index, and likelihood ratio test.ResultsA total of 173 patients were included. Median OS was 6.0 months (95%CI: 3.92~8.08). The independent variables correlated with survival were largest tumor diameter, tumor number, mPVTT extension, and AFP. In the final model, patients were assigned 2 points if largest tumor diameter ≥8 cm, or tumor number ≥2, 1point if main trunk was complete obstructed, or AFP ≥400 ng/ml. By summing up these points, patients were divided into three risk groups according to the score at the 15rd and 85th percentiles, in which median OS were 18, 7, and 3.5months, respectively (p<0.001). The model shown optimal discrimination, performance, and calibration.Conclusionsc-TACE could provide survival benefits in HCC patients with mPVTT and the proposed prognostic stratification may help to identify good candidates for the treatment, and those for whom c-TACE may be futile.

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.

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