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Published in: European Radiology 4/2017

01-04-2017 | Interventional

Transarterial chemoembolization of hepatocellular carcinoma with segmental portal vein tumour thrombus

Authors: Jin Woo Choi, Hyo-Cheol Kim, Jeong-Hoon Lee, Su Jong Yu, Yoon Jun Kim, Jung-Hwan Yoon, Hwan Jun Jae, Saebeom Hur, Myungsu Lee, Jin Wook Chung

Published in: European Radiology | Issue 4/2017

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Abstract

Objectives

To evaluate the clinical outcome and safety of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with segmental or subsegmental portal vein tumour thrombus (sPVTT) in patients with preserved hepatic function, and to address the efficacy of additional chemoinfusion after TACE (TACE+CI).

Methods

From January 2003 to December 2012, TACE was conducted on 81 patients with Child-Pugh score ≤7 who had HCC with sPVTT. Thirty-one of them underwent TACE+CI. The overall survival (OS) and serious adverse events (SAEs) were evaluated. The efficacy of TACE+CI was appraised after adjustment with inverse probability of treatment weighting (IPTW).

Results

The OS after TACE (median, 15.5 months) was significantly related with aspartate aminotransferase (hazard ratio [HR], 1.011), modified Barcelona Clinic Liver Cancer (BCLC) stage D (HR, 2.841), extrahepatic spread (HR, 4.862), and TACE+CI (HR, .367). The SAE incidence was significantly associated with modified BCLC stages (HR, 10.174 [proper-C] and 24.000 [D]). After IPTW adjustment, TACE+CI significantly improved OS (p = .028; HR, .511), but the SAE incidence was not significantly altered (p = .737; HR, .819).

Conclusions

TACE can be an effective and safe treatment option for HCC with sPVTT in patients with preserved hepatic function. Furthermore, additional chemoinfusion can enhance the therapeutic efficacy while maintaining the safety.

Key Points

TACE is effective and safe for treating HCC with sPVTT.
Modified BCLC stages can stratify the risk and benefit of TACE.
Additional chemoinfusion can enhance the therapeutic efficacy while maintaining the safety.
Appendix
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Literature
1.
go back to reference Bruix J, Sherman M, American Association for the Study of Liver Diseases (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022CrossRefPubMedPubMedCentral Bruix J, Sherman M, American Association for the Study of Liver Diseases (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022CrossRefPubMedPubMedCentral
2.
go back to reference European Association for the Study of the Liver, European Organisation for Reresarch and Treatment of Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943CrossRef European Association for the Study of the Liver, European Organisation for Reresarch and Treatment of Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943CrossRef
3.
go back to reference Llovet JM, Bru C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19:329–338CrossRefPubMed Llovet JM, Bru C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19:329–338CrossRefPubMed
4.
go back to reference Forner A, Gilabert M, Bruix J, Raoul JL (2014) Treatment of intermediate-stage hepatocellular carcinoma. Nat Rev Clin Oncol 11:525–535CrossRefPubMed Forner A, Gilabert M, Bruix J, Raoul JL (2014) Treatment of intermediate-stage hepatocellular carcinoma. Nat Rev Clin Oncol 11:525–535CrossRefPubMed
5.
go back to reference Bolondi L, Burroughs A, Dufour JF et al (2012) Heterogeneity of patients with intermediate (BCLC B) Hepatocellular Carcinoma: proposal for a subclassification to facilitate treatment decisions. Semin Liver Dis 32:348–359PubMed Bolondi L, Burroughs A, Dufour JF et al (2012) Heterogeneity of patients with intermediate (BCLC B) Hepatocellular Carcinoma: proposal for a subclassification to facilitate treatment decisions. Semin Liver Dis 32:348–359PubMed
6.
go back to reference Weinmann A, Koch S, Sprinzl M et al (2015) Survival analysis of proposed BCLC-B subgroups in hepatocellular carcinoma patients. Liver Int 35:591–600CrossRefPubMed Weinmann A, Koch S, Sprinzl M et al (2015) Survival analysis of proposed BCLC-B subgroups in hepatocellular carcinoma patients. Liver Int 35:591–600CrossRefPubMed
7.
go back to reference Kim HC, Lee JH, Chung JW et al (2013) Transarterial chemoembolization with additional cisplatin infusion for hepatocellular carcinoma invading the hepatic vein. J Vasc Interv Radiol 24:274–283CrossRefPubMed Kim HC, Lee JH, Chung JW et al (2013) Transarterial chemoembolization with additional cisplatin infusion for hepatocellular carcinoma invading the hepatic vein. J Vasc Interv Radiol 24:274–283CrossRefPubMed
8.
go back to reference Chung GE, Lee JH, Kim HY et al (2011) Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival. Radiology 258:627–634CrossRefPubMed Chung GE, Lee JH, Kim HY et al (2011) Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival. Radiology 258:627–634CrossRefPubMed
9.
go back to reference Miraglia R, Pietrosi G, Maruzzelli L et al (2007) Efficacy of transcatheter embolization/chemoembolization (TAE/TACE) for the treatment of single hepatocellular carcinoma. World J Gastroenterol 13:2952–2955CrossRefPubMedPubMedCentral Miraglia R, Pietrosi G, Maruzzelli L et al (2007) Efficacy of transcatheter embolization/chemoembolization (TAE/TACE) for the treatment of single hepatocellular carcinoma. World J Gastroenterol 13:2952–2955CrossRefPubMedPubMedCentral
10.
go back to reference Sieghart W, Hucke F, Peck-Radosavljevic M (2015) Transarterial chemoembolization: Modalities, indication, and patient selection. J Hepatol 62:1187–1195CrossRefPubMed Sieghart W, Hucke F, Peck-Radosavljevic M (2015) Transarterial chemoembolization: Modalities, indication, and patient selection. J Hepatol 62:1187–1195CrossRefPubMed
11.
go back to reference Xue TC, Xie XY, Zhang L, Yin X, Zhang BH, Ren ZG (2013) Transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a meta-analysis. BMC Gastroenterol 13:60CrossRefPubMedPubMedCentral Xue TC, Xie XY, Zhang L, Yin X, Zhang BH, Ren ZG (2013) Transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a meta-analysis. BMC Gastroenterol 13:60CrossRefPubMedPubMedCentral
12.
go back to reference Kim KM, Kim JH, Park IS et al (2009) Reappraisal of repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein invasion. J Gastroenterol Hepatol 24:806–814CrossRefPubMed Kim KM, Kim JH, Park IS et al (2009) Reappraisal of repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein invasion. J Gastroenterol Hepatol 24:806–814CrossRefPubMed
13.
go back to reference Llovet JM, Ricci S, Mazzaferro V et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359:378–390CrossRefPubMed Llovet JM, Ricci S, Mazzaferro V et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359:378–390CrossRefPubMed
14.
go back to reference Bruix J, Raoul JL, Sherman M et al (2012) Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: subanalyses of a phase III trial. J Hepatol 57:821–829CrossRefPubMed Bruix J, Raoul JL, Sherman M et al (2012) Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: subanalyses of a phase III trial. J Hepatol 57:821–829CrossRefPubMed
15.
go back to reference Mathieu D, Grenier P, Larde D, Vasile N (1984) Portal vein involvement in hepatocellular carcinoma: dynamic CT features. Radiology 152:127–132CrossRefPubMed Mathieu D, Grenier P, Larde D, Vasile N (1984) Portal vein involvement in hepatocellular carcinoma: dynamic CT features. Radiology 152:127–132CrossRefPubMed
16.
go back to reference Tublin ME, Dodd GD 3rd, Baron RL (1997) Benign and malignant portal vein thrombosis: differentiation by CT characteristics. AJR Am J Roentgenol 168:719–723CrossRefPubMed Tublin ME, Dodd GD 3rd, Baron RL (1997) Benign and malignant portal vein thrombosis: differentiation by CT characteristics. AJR Am J Roentgenol 168:719–723CrossRefPubMed
17.
go back to reference Willatt JM, Hussain HK, Adusumilli S, Marrero JA (2008) MR imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology 247:311–330CrossRefPubMed Willatt JM, Hussain HK, Adusumilli S, Marrero JA (2008) MR imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology 247:311–330CrossRefPubMed
18.
go back to reference Kothary N, Weintraub JL, Susman J, Rundback JH (2007) Transarterial chemoembolization for primary hepatocellular carcinoma in patients at high risk. J Vasc Interv Radiol 18:1517–1526CrossRefPubMed Kothary N, Weintraub JL, Susman J, Rundback JH (2007) Transarterial chemoembolization for primary hepatocellular carcinoma in patients at high risk. J Vasc Interv Radiol 18:1517–1526CrossRefPubMed
19.
go back to reference Choi JW, Chung JW, Cho YK et al (2014) Transarterial chemoembolization for hepatocellular carcinomas with central bile duct invasion: safety, prognosis, and predictive factors. Cardiovasc Intervent Radiol 38:937–945CrossRefPubMed Choi JW, Chung JW, Cho YK et al (2014) Transarterial chemoembolization for hepatocellular carcinomas with central bile duct invasion: safety, prognosis, and predictive factors. Cardiovasc Intervent Radiol 38:937–945CrossRefPubMed
20.
go back to reference Kim SH, Kim YJ, Lee JM et al (2007) Esophageal varices in patients with cirrhosis: multidetector CT esophagography--comparison with endoscopy. Radiology 242:759–768CrossRefPubMed Kim SH, Kim YJ, Lee JM et al (2007) Esophageal varices in patients with cirrhosis: multidetector CT esophagography--comparison with endoscopy. Radiology 242:759–768CrossRefPubMed
21.
go back to reference Kim H, Choi D, Gwak GY et al (2009) Evaluation of esophageal varices on liver computed tomography: receiver operating characteristic analyses of the performance of radiologists and endoscopists. J Gastroenterol Hepatol 24:1534–1540CrossRefPubMed Kim H, Choi D, Gwak GY et al (2009) Evaluation of esophageal varices on liver computed tomography: receiver operating characteristic analyses of the performance of radiologists and endoscopists. J Gastroenterol Hepatol 24:1534–1540CrossRefPubMed
22.
go back to reference Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:52–60CrossRefPubMed Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:52–60CrossRefPubMed
23.
go back to reference Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European association for the study of the liver. J Hepatol 35:421–430CrossRefPubMed Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European association for the study of the liver. J Hepatol 35:421–430CrossRefPubMed
24.
go back to reference Brown DB, Nikolic B, Covey AM et al (2012) Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol 23:287–294CrossRefPubMed Brown DB, Nikolic B, Covey AM et al (2012) Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol 23:287–294CrossRefPubMed
25.
go back to reference Imai Y, Chikayama T, Nakazawa M et al (2011) Usefulness of miriplatin as an anticancer agent for transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma. J Gastroenterol 47:179–186CrossRefPubMed Imai Y, Chikayama T, Nakazawa M et al (2011) Usefulness of miriplatin as an anticancer agent for transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma. J Gastroenterol 47:179–186CrossRefPubMed
26.
go back to reference Vogl TJ, Lammer J, Lencioni R et al (2011) Liver, gastrointestinal, and cardiac toxicity in intermediate hepatocellular carcinoma treated with PRECISION TACE with drug-eluting beads: results from the PRECISION V randomized trial. AJR Am J Roentgenol 197:W562–W570CrossRefPubMed Vogl TJ, Lammer J, Lencioni R et al (2011) Liver, gastrointestinal, and cardiac toxicity in intermediate hepatocellular carcinoma treated with PRECISION TACE with drug-eluting beads: results from the PRECISION V randomized trial. AJR Am J Roentgenol 197:W562–W570CrossRefPubMed
27.
go back to reference Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199–S202CrossRefPubMed Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199–S202CrossRefPubMed
28.
go back to reference Cleophas TJ, Zwinderman AH (2006) Clinical trials are often false positive: a review of simple methods to control this problem. Curr Clin Pharmacol 1:1–4CrossRefPubMed Cleophas TJ, Zwinderman AH (2006) Clinical trials are often false positive: a review of simple methods to control this problem. Curr Clin Pharmacol 1:1–4CrossRefPubMed
29.
go back to reference Memon K, Kulik LM, Lewandowski RJ et al (2014) Comparative study of staging systems for hepatocellular carcinoma in 428 patients treated with radioembolization. J Vasc Interv Radiol 25:1056–1066CrossRefPubMedPubMedCentral Memon K, Kulik LM, Lewandowski RJ et al (2014) Comparative study of staging systems for hepatocellular carcinoma in 428 patients treated with radioembolization. J Vasc Interv Radiol 25:1056–1066CrossRefPubMedPubMedCentral
30.
go back to reference Kulik LM, Carr BI, Mulcahy MF et al (2008) Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 47:71–81CrossRefPubMed Kulik LM, Carr BI, Mulcahy MF et al (2008) Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 47:71–81CrossRefPubMed
31.
go back to reference Kokudo N, Hasegawa K, Akahane M et al (2015) Evidence-based clinical practice guidelines for hepatocellular carcinoma: the Japan society of hepatology 2013 update (3rd JSH-HCC Guidelines). Hepatol Res 45 Kokudo N, Hasegawa K, Akahane M et al (2015) Evidence-based clinical practice guidelines for hepatocellular carcinoma: the Japan society of hepatology 2013 update (3rd JSH-HCC Guidelines). Hepatol Res 45
32.
go back to reference Luo J, Guo RP, Lai EC et al (2011) Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis: a prospective comparative study. Ann Surg Oncol 18:413–420CrossRefPubMed Luo J, Guo RP, Lai EC et al (2011) Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis: a prospective comparative study. Ann Surg Oncol 18:413–420CrossRefPubMed
33.
go back to reference Marrero JA, Fontana RJ, Barrat A et al (2005) Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology 41:707–716CrossRefPubMed Marrero JA, Fontana RJ, Barrat A et al (2005) Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology 41:707–716CrossRefPubMed
34.
go back to reference Sahara S, Kawai N, Sato M et al (2012) Prospective evaluation of transcatheter arterial chemoembolization (TACE) with multiple anti-cancer drugs (epirubicin, cisplatin, mitomycin c, 5-fluorouracil) compared with TACE with epirubicin for treatment of hepatocellular carcinoma. Cardiovasc Intervent Radiol 35:1363–1371CrossRefPubMed Sahara S, Kawai N, Sato M et al (2012) Prospective evaluation of transcatheter arterial chemoembolization (TACE) with multiple anti-cancer drugs (epirubicin, cisplatin, mitomycin c, 5-fluorouracil) compared with TACE with epirubicin for treatment of hepatocellular carcinoma. Cardiovasc Intervent Radiol 35:1363–1371CrossRefPubMed
35.
go back to reference Marelli L, Stigliano R, Triantos C et al (2007) Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol 30:6–25CrossRefPubMed Marelli L, Stigliano R, Triantos C et al (2007) Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol 30:6–25CrossRefPubMed
36.
go back to reference Huang M, Lin Q, Wang H et al (2016) Survival benefit of chemoembolization plus Iodine125 seed implantation in unresectable hepatitis B-related hepatocellular carcinoma with PVTT: a retrospective matched cohort study. Eur Radiol. doi:10.1007/s00330-015-4198-x Huang M, Lin Q, Wang H et al (2016) Survival benefit of chemoembolization plus Iodine125 seed implantation in unresectable hepatitis B-related hepatocellular carcinoma with PVTT: a retrospective matched cohort study. Eur Radiol. doi:10.​1007/​s00330-015-4198-x
37.
go back to reference Zhang YF, Guo RP, Zou RH et al (2015) Efficacy and safety of preoperative chemoembolization for resectable hepatocellular carcinoma with portal vein invasion: a prospective comparative study. Eur Radiol. doi:10.1007/s00330-015-4021-8 Zhang YF, Guo RP, Zou RH et al (2015) Efficacy and safety of preoperative chemoembolization for resectable hepatocellular carcinoma with portal vein invasion: a prospective comparative study. Eur Radiol. doi:10.​1007/​s00330-015-4021-8
Metadata
Title
Transarterial chemoembolization of hepatocellular carcinoma with segmental portal vein tumour thrombus
Authors
Jin Woo Choi
Hyo-Cheol Kim
Jeong-Hoon Lee
Su Jong Yu
Yoon Jun Kim
Jung-Hwan Yoon
Hwan Jun Jae
Saebeom Hur
Myungsu Lee
Jin Wook Chung
Publication date
01-04-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 4/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4511-3

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