The Efficacy and Prognostic Factors of the Combination of TACE and Apatinib for the Treatment of BCLC Stage C Hepatocellular Carcinoma

Objective: Apatinib is a inhibitor of vascular endothelial growth factor receptor-2. To explore the efficacy and prognostic factors of transarterial chemoembolization (TACE) combined with apatinib in the treatment of Barcelona Clinic Liver Cancer stage C (BCLC C) hepatocellular carcinoma (HCC).Methods: Clinical data of 146 HCC patients with BCLC stage C admitted to our hospital were collected and analyzed retrospectively, of which 76 cases were treated with TACE combined with apatinib (TACE-apatinib) and 70 with TACE alone. The tumor response, survival time, and adverse events were compared between the two groups, and the factors affecting the prognosis were analyzed.Results: The objective response rate (ORR) and disease control rate (DCR) in the TACE-apatinib group were higher than in the TACE-alone group (ORR: 42.10 vs. 25.71%, P = 0.03; DCR: 84.21 vs. 55.71%, P = 0.001). The median time to progression (TTP) and overall survival (OS) in the TACE-apatinib group were longer than in the TACE-alone group (TTP: 5.5 vs. 3.7 months, P = 0.02; OS: 10.0 vs. 6.2 months, P = 0.01). Univariate and multivariate Cox regression analysis showed that tumor size, Child-Pugh class, and the presence of the portal vein tumor thrombus affect the prognosis of patients. Subgroup analysis revealed that TACE-apatinib therapy resulted in a higher OS in patients with tumor size <10 cm, without portal vein tumor thrombus, and with Child-Pugh class A (P < 0.05). The likelihood of adverse events (hand-foot syndrome, hypertension, oral ulcer) was significantly higher in the increased in the TACE-apatinib group than in the TACE alone group (P < 0.05).Conclusion: TACE-apatinib is an effective and safe method for the treatment of BCLC stage C HCC. Tumor size, Child-Pugh class, and portal vein tumor thrombus affect survival time in HCC patients with BCLC stage C.

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Distant survival for patients undergoing surgery using volatile versus IV anesthesia for hepatocellular carcinoma with portal vein tumor thrombus: a retrospective study

BMC Anesthesiology ◽

10.1186/s12871-020-01111-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xiao-Yan Meng ◽

Xiu-Ping Zhang ◽

Zhe Sun ◽

Hong-Qian Wang ◽

Wei-Feng Yu

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Portal Vein ◽

Tumor Thrombus ◽

Cox Regression ◽

Cancer Recurrence ◽

Portal Vein Tumor Thrombus ◽

Cox Regression Analysis ◽

The Impact ◽

Underlying Pathophysiology

Abstract Background Whether anesthesia type is associated with the surgical outcome of Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) remains to be determined. This study aims to investigate the impact of volatile inhalational anesthesia (INHA) versus total IV anesthesia (TIVA) on the survival outcomes in HCC patients with PVTT. Methods A cohort of in-patients whom were diagnosed of HCC with PVTT in Eastern Hepatobiliary Surgery Hospital, Shanghai, China, from January 1, 2008 to December 24, 2012 were identified. Surgical patients receiving the INHA and TIVA were screened out. The overall survival (OS), recurrence-free survival (RFS) and several postoperative adverse events were compared according to anesthesia types. Results A total of 1513 patients were included in this study. After exclusions are applied, 263 patients remain in the INHA group and 208 in the TIVA group. Patients receiving INHA have a lower 5-year overall survival rate than that of patients receiving TIVA [12.6% (95% CI, 9.0 to 17.3) vs. 17.7% (95% CI, 11.3 to 20.8), P = 0.024]. Results of multivariable Cox-regression analysis also identify that INHA anesthesia is significantly associated with mortality and cancer recurrence after surgery compare to TIVA, with HR (95%CI) of 1.303 (1.065, 1.595) and 1.265 (1.040, 1.539), respectively. Subgroup analysis suggested that in more severe cancer patients, the worse outcome related to INHA might be more significant. Conclusion This retrospective analysis identifies that TIVA is associated with better outcomes compared with INHA. Future prospective studies clinical and translational studies are required to verify this difference and investigate underlying pathophysiology.

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

BioMed Research International ◽

10.1155/2014/194278 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 7

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.

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Distant Survival for Patients Undergoing Surgery Using Volatile versus IV Anesthesia for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: A Retrospective study

10.21203/rs.2.15935/v1 ◽

2019 ◽

Author(s):

Xiao-Yan Meng ◽

Xiu-Ping Zhang ◽

Hong-Qian Wang ◽

Weifeng Yu

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Regression Analysis ◽

Retrospective Study ◽

Survival Rate ◽

Portal Vein ◽

Subgroup Analysis ◽

Tumor Thrombus ◽

Portal Vein Tumor Thrombus ◽

Cox Regression Analysis

Abstract Background Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) have lower postoperative survival rate, and anesthesia type may have an effect on tumor recurrence and metastasis.Methods A retrospective study was conducted in Eastern Hepatobiliary Surgery Hospital, Shanghai, China, from January 1, 2008 to December 24, 2012. A total of 1513 HCC patients with PVTT were delivered in the study period. Patients receiving the volatile inhalational anesthesia (INHA) and total IV (TIVA) anesthesia were screen out for comparison. The primary outcome was 5-year overall survival (OS), and secondary outcomes included recurrence-free survival (RFS), postoperative adverse events and liver function. Cox regression analysis was applied to balance confounding variables and estimate risk factors for mortality. Then subgroup analysis of anesthesia type on potential risk factors which were acquired in the final multivariable model were performed.Results After exclusions are applied, 263 patients remain in the INHA group and 208 in the TIVA group. Patients receiving INHA anesthesia have a lower 5-year survival rate than that of patients receiving TIVA anesthesia [12.6% (95% CI, 9.0 to 17.3) vs. 17.7% (95% CI, 11.3 to 20.8), P=0.024]. Results from multivariable regression analysis also identify that INHA anesthesia is significantly associated with the OS ang RFS compared with TIVA anesthesia, with HR (95%CI) of 1.303 (1.065, 1.595) and 1.265 (1.040, 1.539), respectively. Subgroup analysis suggested that in more severe cancer patients, the worse outcome related to INHA might be more significant.Conclusion This retrospective analysis identifies that patients receiving TIVA have better survival rate compare to receiving INHA in HCC patients with PVTT. Future prospective researches are urgent to verify this difference and figure out underlying causes of it.

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Analysis of surgical treatment and prognostic factors for hepatocellular carcinoma with portal vein tumor thrombus

Translational Cancer Research ◽

10.21037/tcr.2016.11.78 ◽

2017 ◽

Vol 6 (1) ◽

pp. 247-253

Author(s):

Jingyu Cao ◽

Zusen Wang ◽

Shengkun Wu ◽

Yao Yu ◽

Chengzhan Zhu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factors ◽

Surgical Treatment ◽

Portal Vein ◽

Tumor Thrombus ◽

Portal Vein Tumor Thrombus

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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

Frontiers in Oncology ◽

10.3389/fonc.2021.671171 ◽

2021 ◽

Vol 11 ◽

Cited By ~ 1

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.

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Treatment of Hepatocellular Carcinoma-associated Portal Vein Tumor Thrombus Using Combination of Portal Vein Stent Insertion and Endovascular Lodine-125 Seed-strip Implantation Followed by Transcatheter Arterial Chemoembolization- Sorafenib

10.21203/rs.3.rs-88313/v1 ◽

2020 ◽

Author(s):

Shuangxi Li ◽

Baohua Li ◽

Lei Li ◽

Fangyu Xu ◽

Xujun Yang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Portal Vein ◽

Disease Control ◽

Tumor Thrombus ◽

Transcatheter Arterial Chemoembolization ◽

Cox Regression ◽

Portal Vein Tumor Thrombus ◽

Cox Regression Analysis ◽

Type Iii ◽

Arterial Chemoembolization

Abstract BackgroundTo evaluate the efficacy of portal vein stent (PVS) insertion and endovascular iodine-125 (125I) seed-strip implantation followed by transcatheter arterial chemoembolization (TACE)-sorafenib (PVS-125I-TACE-S) in patients with hepatocellular carcinoma (HCC)-associated portal vein tumor thrombus (PVTT).MethodsThis retrospective analysis was performed on 53 consecutive HCC patients with PVTT between May 2014 and July 2018. Twenty-eight patients were treated via PVS-125I-TACE-S, and 25 patients were treated by TACE-S. Hepatic function, disease control, and overall survival (OS) in both groups were analyzed. The Albumin-Bilirubin (ALBI) score approach was used as a means of evaluating liver function, and a Cox regression analysis was utilized to determine which factors were linked to treatment outcomes.ResultsNo preoperative differences in ALBI scores between groups (P=0.724), nor did these scores at 1-month postoperative (P=0.666). However, these scores were significantly different at 3 (P=0.007) and 6 (P=0.044) months postoperatively. PVS-125I-TACE-S exhibiting higher rates of disease control (71.4% vs. 44.0%, P=0.043) after 6 months of treatment and extended OS duration (342.0 vs 231.0 days, P=0.007). A stratified analysis revealed OS in patients with type II PVTT did not differ significantly (313.0 vs. 321.0 days, P=0.689), but OS with type III did (344.0 vs. 226.0 days, P=0.002). A multivariate analysis revealed that tumor size > 10 cm was independently predictive of poor prognosis (P=0.002), whereas PVS-125I-TACE-S was a predictor of a favorable patient prognosis (P=0.040).ConclusionPVS-125I-TACE-S represents a potentially viable strategy for improving hepatic functionality, disease control, and OS in HCC with type III PVTT.

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Clinical Values and Markers of Radiation-Induced Liver Disease for Hepatocellular Carcinoma With Portal Vein Tumor Thrombus Treated With Stereotactic Body Radiotherapy

Frontiers in Oncology ◽

10.3389/fonc.2021.760090 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jun Jia ◽

Jing Sun ◽

Xuezhang Duan ◽

Wengang Li

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Liver Disease ◽

Portal Vein ◽

Survival Time ◽

Stereotactic Body Radiotherapy ◽

Tumor Thrombus ◽

Portal Vein Tumor Thrombus ◽

Overall Survival Time ◽

Radiation Induced

BackgroundInformation about radiation-induced liver disease (RILD) in hepatocellular carcinoma (HCC) patients preexisting hepatitis B cirrhosis with portal vein tumor thrombus (PVTT) extended to the main portal vein treated with stereotactic body radiotherapy (SBRT) is still inadequate and the predictive markers for RILD have not been cleared in these patients. The aim of the study is to identify factors that can be used to predict RILD and to evaluate the influence of RILD in these patients.MethodsIn our study, 59 patients were analyzed and evaluated from December 2015 to June 2019, according to the entry criteria. After treatment, 59 patients were followed up within the first month and then every 3 months. Hematology test, tumor markers, three-phasic CT scan of the lungs, and CT or MRI scan of the liver were performed at each follow up.ResultsMedian overall survival time was 10.7 months (range, 5.8 to 14.9). RILD appeared in 17 of the 59 patients (28.8%) at the 3rd month after SBRT. In the univariate analysis, not only the CP score class (A or B) but also each different pretreatment CP score (p < 0.05) was a significant predictive factor of RILD. More RILD cases were detected with the increase of CP score. The recovery rate decreased as the baseline CP score increased (p < 0.05). It was found that the overall survival time was affected by only baseline CP score and RILD (p < 0.05).ConclusionsThe development of RILD has a dependency on the CP score in these patients. CP scores before treatment and RILD are significantly associated with overall survival. SBRT is an effective and safe method for patients with CP ≤ B7. For patients with CP-B8, liver function should be monitored more frequently. It is not safe enough for the SBRT treatment in CP-B9 patients.

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Surgical Strategy for Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus Based on Prognostic Factors

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-009-0854-2 ◽

2009 ◽

Vol 13 (6) ◽

pp. 1078-1083 ◽

Cited By ~ 42

Author(s):

Kazuhiro Kondo ◽

Kazuo Chijiiwa ◽

Masahiro Kai ◽

Kazuhiro Otani ◽

Koki Nagaike ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factors ◽

Portal Vein ◽

Tumor Thrombus ◽

Surgical Strategy ◽

Portal Vein Tumor Thrombus

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Association of Preoperative Coagulability With Incidence and Extent of Portal Vein Tumor Thrombus and Survival Outcomes in Hepatocellular Carcinoma After Hepatectomy: A Large-Scale, Multicenter Study

Frontiers in Oncology ◽

10.3389/fonc.2021.697073 ◽

2021 ◽

Vol 11 ◽

Author(s):

Xiu-Ping Zhang ◽

Teng-Fei Zhou ◽

Jin-Kai Feng ◽

Zi-Yang Sun ◽

Zuo-Jun Zhen ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Portal Vein ◽

Tumor Thrombus ◽

Large Scale ◽

Cox Regression ◽

International Normalized Ratio ◽

Portal Vein Tumor Thrombus ◽

Survival Outcomes ◽

Cox Regression Analysis ◽

Kaplan Meier

BackgroundOccurrence of portal vein tumor thrombus (PVTT) worsens the outcomes of hepatocellular carcinoma (HCC) and imparts high economic burden on society. Patients with high risks of having hypercoagulation are more likely to experience thrombosis. Herein, we examined how preoperative international normalized ratio (INR) was related to the incidence and extent of PVTT, and associated with survival outcomes in HCC patients following R0 liver resection (LR).MethodsPatients with HCC and PVTT were enrolled from six major hospitals in China. The overall survival (OS) and recurrence-free survival (RFS) rates of individuals with different INR levels were assessed with Cox regression analysis as well as Kaplan-Meier method.ResultsThis study included 2207 HCC patients, among whom 1005 patients had concurrent PVTT. HCC patients in the Low INR group had a significantly higher incidence of PVTT and more extensive PVTT than the Normal and High INR groups (P<0.005). Of the 592 HCC subjects who had types I/II PVTT following R0 LR, there were 106 (17.9%), 342 (57.8%) and 144 (24.3%) patients in the High, Normal and Low INR groups, respectively. RFS and OS rates were markedly worse in patients in the Low INR group relative to those in the Normal and High INR groups (median RFS, 4.87 versus 10.77 versus 11.40 months, P<0.001; median OS, 6.30 versus 11.83 versus 12.67 months, P<0.001).ConclusionPreoperative INR influenced the incidence and extent of PVTT in HCC. Particularly, patients with HCC and PVTT in the Low INR group had worse postoperative prognosis relative to the High and Normal INR groups.

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Efficacy and Safety of Lenvatinib for Advanced Hepatocellular Carcinoma Patients Beyond REFLECT Study Indications in a Real-World Setting in China

10.21203/rs.3.rs-743501/v1 ◽

2021 ◽

Author(s):

Guangxin Li ◽

Yu Zhang ◽

Yanmei Yang ◽

Gong Li

Keyword(s):

Hepatocellular Carcinoma ◽

Adverse Events ◽

Portal Vein ◽

Real World ◽

Tumor Thrombus ◽

Liver Volume ◽

Portal Vein Tumor Thrombus ◽

Advanced Hepatocellular Carcinoma ◽

Main Portal Vein ◽

Real World Setting

Abstract Background/purpose: Lenvatinib was found to be non-inferior to sorafenib in a Phase 3 REFLECT trial on advanced hepatocellular carcinoma. However, patients with a liver tumor volume of greater than 50% of total liver volume or with main portal vein tumor thrombus, which often occurs in clinical practice, were excluded from the REFLECT trial. This study aimed to examine the safety and efficacy of lenvatinib on patients beyond REFLECT study indications in a real-world setting.Method: This was a retrospective, single-center observational study focused on unresectable hepatocellular carcinoma (u-HCC) patients with the tumor accounting for more than 50% of the liver volume or with main portal vein tumor thrombus. From June 2018 to February 2019, 21 u-HCC patients with above characteristics were enrolled. The therapeutic effects were determined using the modified Response Evaluation Criteria in Solid Tumors (m-RECIST) in the 12th week. Grades of adverse events followed with the Common Terminology Criteria for Adverse Events version (CTCAE) 4.0. The median Progression-Free Survival (PFS) and median Over Survival (OS) were determined at the 12th month.Results: The median observation period was 11.5 months. Fatigue, leukopenia and dysphoria were the most frequent adverse events. Leukopenia, hand-foot skin reaction and decreased appetite were the most frequent adverse events, and were higher than Grade 2. 7 of the patients had elevated Child-Pugh scores, 3 of whom increased from Child-Pugh A to B. All of the adverse events could be controlled by appropriate dose reduction, interruption and symptomatic treatment. No liver function failure occurred. The probability of tumor marker (AFP or PIVKA-II) decline was 100% and 60% at one month and three months after administration respectively. In the m-RECIST evaluation in the 12th week, 0, 7, 7 and 7 patients achieved complete response, partial response, stable disease and progressive disease respectively. The objective response rate was 33.3%. The median PFS and OS was 5.3 and 11.2 , respectively. 1 year survival rate was 42.9%.Conclusion: Lenvatinib treatment can be accomplished with safety and a good response for patients beyond REFLECT study indications in a real-world setting.

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