Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2019

01-05-2019 | Liver Resection | Hepatobiliary Tumors

Postoperative Adjuvant Transarterial Chemoembolization Improves Outcomes of Hepatocellular Carcinoma Associated with Hepatic Vein Invasion: A Propensity Score Matching Analysis

Authors: Xiu-Ping Zhang, MD, Yan-Chen Liu, BM, Zhen-Hua Chen, MD, Ju-Xian Sun, MD, Kang Wang, MD, Zong-Tao Chai, MD, Jie Shi, MD, Wei-Xing Guo, MD, Meng-Chao Wu, MD, Wan Yee Lau, MD, Shu-Qun Cheng, MD

Published in: Annals of Surgical Oncology | Issue 5/2019

Login to get access

Abstract

Background

Vascular invasion is a major determinant of survival outcomes after curative resection for hepatocellular carcinoma (HCC) patients. This study was designed to investigate the efficacy of postoperative adjuvant transarterial chemoembolization (PA-TACE) in patients with HCC with hepatic vein tumor thrombus (HVTT).

Methods

Data from patients who underwent LR for HCC with HVTT at the Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed. The survival outcomes for patients who underwent PA-TACE after LR were compared with those who underwent LR alone. Propensity score matching (PSM) analysis was performed to match patients in a ratio of 1:1.

Results

All included 319 patients who underwent LR for HCC with HVTT, 134 underwent LR alone (the LR group), and 185 patients underwent in adjuvant TACE (the PA-TACE group). PSM matched 107 patients in two groups. The overall survival (OS) and recurrence-free survival (RFS) were significantly better for patients in the PA-TACE group than the LR group (for OS: before PSM, P < 0.001; after PSM, P = 0.004; for RFS: before PSM, P < 0.001; after PSM, P = 0.013), respectively. On subgroup analysis, equivalent acceptable results were obtained in patients with peripheral HVTT (pHVTT) and major HVTT (mHVTT). However, PA-TACE resulted in no survival benefits for patients when the HVTT had extended to the inferior vena cava (IVCTT).

Conclusions

PA-TACE was associated with significantly better survival outcomes than LR alone for patients with HCC and HVTT (pHVTT and mHVTT). There was no survival benefits in patients whose HVTT had extended to form IVCTT.
Appendix
Available only for authorised users
Literature
1.
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Can J Clin. 2015;65(2):87–108.CrossRef
2.
Marrero JA, Kulik LM, Sirlin C, et al. Diagnosis, staging and management of hepatocellular carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018;68(2):723–750.CrossRefPubMed
3.
Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology. 2016;150(4):835–53.CrossRefPubMed
4.
Aldrighetti L, Pulitano C, Catena M, et al. Liver resection with portal vein thrombectomy for hepatocellular carcinoma with vascular invasion. Ann Surg Oncol. 2009;16(5):1254.CrossRefPubMed
5.
Lu XJ, Dong J, Ji LJ, et al. Safety and efficacy of TACE and gamma knife on hepatocellular carcinoma with portal vein invasion. Gut. 2016;65(4):715–6.CrossRefPubMed
6.
7.
Kokudo T, Hasegawa K, Yamamoto S, et al. Surgical treatment of hepatocellular carcinoma associated with hepatic vein tumor thrombosis. J Hepatol. 2014;61(3):583–8.CrossRefPubMed
8.
Kokudo T, Hasegawa K, Matsuyama Y, et al. Liver resection for hepatocellular carcinoma associated with hepatic vein invasion: a Japanese nationwide survey. Hepatology. 2017;66(2):510–7.CrossRefPubMed
9.
Kokudo T, Hasegawa K, Matsuyama Y, et al. Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion. J Hepatol. 2016;65(5):938–43.CrossRefPubMed
10.
Wang K, Guo WX, Chen MS, et al. Multimodality treatment for hepatocellular carcinoma with portal vein tumor thrombus: a large-scale, multicenter, propensity mathching score analysis. Medicine. 2016;95(11):e3015.CrossRefPubMedPubMedCentral
11.
Zhang XP, Wang K, Chen ZH, Cheng SQ. Hepatocellular carcinoma with hepatic vein invasion should not be considered a contraindication for liver resection. Hepatology. 2017;67(2):804–805.CrossRefPubMed
12.
Lee JM, Jang BK, Lee YJ, et al. Survival outcomes of hepatic resection compared with transarterial chemoembolization or sorafenib for hepatocellular carcinoma with portal vein tumor thrombosis. Clin Mol Hepatol. 2016;22(1):160–7.CrossRefPubMedPubMedCentral
13.
Shaohua L, Qiaoxuan W, Peng S, et al. Surgical strategy for hepatocellular carcinoma patients with portal/hepatic vein tumor thrombosis. PloS ONE. 2015;10(6):e0130021.CrossRefPubMedPubMedCentral
14.
Itoh A, Sadamori H, Yabushita K, et al. Advanced hepatocellular carcinoma with hepatic vein tumor thrombosis and renal dysfunction after hepatic arterial infusion chemotherapy effectively treated by liver resection with active veno-venous bypass: report of a case. BMC Cancer 2016;16:705.CrossRefPubMedPubMedCentral
15.
Hyun MH, Lee YS, Kim JH, et al. Hepatic resection compared to chemoembolization in intermediate- to advanced-stage hepatocellular carcinoma: a meta-analysis of high-quality studies. Hepatology. 2018;68(3):977–993.CrossRefPubMed
16.
Tong Y, Li Z, Liang Y, et al. Postoperative adjuvant TACE for patients of hepatocellular carcinoma in AJCC stage I: friend or foe? a propensity score analysis. Oncotarget. 2017;8(16):26671–8.CrossRefPubMedPubMedCentral
17.
Wang Z, Ren Z, Chen Y, et al. Adjuvant transarterial chemoembolization for hbv-related hepatocellular carcinoma after resection: a randomized controlled study. Clin Cancer Res. 2018;24(9):2074–81.CrossRefPubMed
18.
Liu S, Guo L, Li H, et al. Postoperative adjuvant trans-arterial chemoembolization for patients with hepatocellular carcinoma and portal vein tumor thrombus. Ann Surg Oncol. 2018;25(7):2098–104.CrossRefPubMed
19.
Peng ZW, Guo RP, Zhang YJ, Lin XJ, Chen MS, Lau WY. Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus. Cancer. 2012;118(19):4725–36.CrossRefPubMed
20.
Zhang YF, Wei W, Guo ZX, Wang JH, Shi M, Guo RP. Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with hepatic vein tumor thrombus. Japanese J Clin Oncol. 2015;45(9):837–43.CrossRef
21.
Wang Y, Yuan L, Ge RL, Sun Y, Wei G. Survival benefit of surgical treatment for hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus: results of a retrospective cohort study. Ann Surg Oncol. 2013;20(3):914–22.CrossRefPubMed
22.
Sun JJ, Wang K, Zhang CZ, et al. Postoperative adjuvant transcatheter arterial chemoembolization after R0 hepatectomy improves outcomes of patients who have hepatocellular carcinoma with microvascular invasion. Ann Surg Oncol. 2016;23(4):1344–51.CrossRefPubMed
23.
Wang K, Guo W, Li N, et al. Alpha-1-fucosidase as a prognostic indicator for hepatocellular carcinoma following hepatectomy: a large-scale, long-term study. Br J Cancer. 2014;110(7):1811–19.CrossRefPubMedPubMedCentral
24.
Zhang YF, Wei W, Wang JH, et al. Transarterial chemoembolization combined with sorafenib for the treatment of hepatocellular carcinoma with hepatic vein tumor thrombus. OncoTargets Ther. 2016;9:4239–46.CrossRef
25.
Fleming CJ, Andrews JC, Wiseman GA, Gansen DN, Roberts LR. Hepatic vein tumor thrombus as a risk factor for excessive pulmonary deposition of microspheres during TheraSphere therapy for unresectable hepatocellular carcinoma. J Vasc Interv Radiol. 2009;20(11):1460–3.CrossRefPubMed
26.
Kim HC, Lee JH, Chung JW, et al. Transarterial chemoembolization with additional cisplatin infusion for hepatocellular carcinoma invading the hepatic vein. J Vasc Interv Radiol. 2013;24(2):274–83.CrossRefPubMed
27.
Jiang C, Wang Z, Xu Q, Wu X, Ding Y. Inferior right hepatic vein-preserving major right hepatectomy for hepatocellular carcinoma in patients with significant fibrosis or cirrhosis. World J Surg. 2014;38(1):159–67.CrossRefPubMed
28.
Zhang T, Huang JW, Bai YN, Wu H, Zeng Y. Recurrence and survivals following hepatic resection for hepatocellular carcinoma with major portal/hepatic vein tumor thrombus. Hepatol Res. 2014;44(7):761–8.CrossRefPubMed
29.
Ye JZ, Chen JZ, Li ZH, et al. Efficacy of postoperative adjuvant transcatheter arterial chemoembolization in hepatocellular carcinoma patients with microvascular invasion. World J Gastroenterol. 2017;23(41):7415–24.CrossRefPubMedPubMedCentral
30.
Pesi B, Ferrero A, Grazi GL, et al. Liver resection with thrombectomy as a treatment of hepatocellular carcinoma with major vascular invasion: results from a retrospective multicentric study. Am J Surg. 2015;210(1):35–44.CrossRefPubMed
31.
Biolato M, Marrone G, Racco S, et al. Transarterial chemoembolization (TACE) for unresectable HCC: a new life begins? Eur Rev Med Pharm Sci. 2010;14(4):356–62.
32.
Ke-Wei L, Tian-Fu W, Xi L, et al. The effect of postoperative TACE on prognosis of HCC with microscopic venous invasion. Hepato-gastroenterology. 2012;59(118):1944–6.PubMed
33.
Lencioni R, Llovet JM, Han G, et al. Sorafenib or placebo plus TACE with doxorubicin-eluting beads for intermediate stage HCC: The SPACE trial. J Hepatol. 2016;64(5):1090–8.CrossRefPubMed
34.
35.
Klompenhouwer EG, Dresen RC, Verslype C, et al. Transarterial radioembolization following chemoembolization for unresectable hepatocellular carcinoma: response based on apparent diffusion coefficient change is an independent predictor for survival. Cardiovasc Interv Radiol. 2018.
36.
Guo T, Wu P, Liu P, et al. Identifying the best anticancer agent combination in TACE for HCC patients: a network meta-analysis. J Cancer. 2018;9(15):2640–9.CrossRefPubMedPubMedCentral
37.
Weiss KE, Sze DY, Rangaswami AA, et al. Transarterial chemoembolization in children to treat unresectable hepatocellular carcinoma. Pediatric Transpl. 2018;22(4):e13187.CrossRef
38.
Kirstein MM, Voigtlander T, Schweitzer N, et al. Transarterial chemoembolization versus sorafenib in patients with hepatocellular carcinoma and extrahepatic disease. United Eur Gastroenterol J. 2018;6(2):238–46.CrossRef
39.
Leng JJ, Xu YZ, Dong JH. Efficacy of transarterial chemoembolization for hepatocellular carcinoma with portal vein thrombosis: a meta-analysis. ANZ J Surg. 2016;86(10):816–20.CrossRefPubMed
40.
Zhao Y, Duran R, Chapiro J, et al. Transarterial chemoembolization for the treatment of advanced-stage hepatocellular carcinoma. J Gastrointest Surg. 2016;20(12):2002–9.CrossRefPubMedPubMedCentral
41.
Zhang XP, Wang K, Li N, et al. Survival benefit of hepatic resection versus transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a systematic review and meta-analysis. BMC Cancer. 2017;17(1):902.CrossRefPubMedPubMedCentral
42.
Takano M, Kokudo T, Miyazaki Y, et al. Complete response with sorafenib and transcatheter arterial chemoembolization in unresectable hepatocellular carcinoma. World J Gastroenterol. 2016;22(42):9445–50.CrossRefPubMedPubMedCentral
Metadata
Title
Postoperative Adjuvant Transarterial Chemoembolization Improves Outcomes of Hepatocellular Carcinoma Associated with Hepatic Vein Invasion: A Propensity Score Matching Analysis
Authors
Xiu-Ping Zhang, MD
Yan-Chen Liu, BM
Zhen-Hua Chen, MD
Ju-Xian Sun, MD
Kang Wang, MD
Zong-Tao Chai, MD
Jie Shi, MD
Wei-Xing Guo, MD
Meng-Chao Wu, MD
Wan Yee Lau, MD
Shu-Qun Cheng, MD
Publication date
01-05-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07223-z

Other articles of this Issue 5/2019

Annals of Surgical Oncology 5/2019 Go to the issue

Gastrointestinal Oncology

Transanal Minimally Invasive Surgery (TAMIS) for Large Rectal Polyps

Translational Research and Biomarkers

Cellular Senescence, Represented by Expression of Caveolin-1, in Cancer-Associated Fibroblasts Promotes Tumor Invasion in Pancreatic Cancer

Sarcoma

IMRT Should Be Considered a Standard-of-Care Approach for Radiation Therapy for Soft Tissue Sarcoma of the Extremity

ASO Author Reflections

ASO Author Reflections: Pelvic Exenteration for Patients with Primary and Recurrent Pelvic Cancer

Thoracic Oncology

Proposal of a Nomogram for Predicting Survival in Patients with Siewert Type II Adenocarcinoma of the Esophagogastric Junction After Preoperative Radiation

Melanoma

Trends in Sentinel Lymph Node Biopsy Enactment for Cutaneous Melanoma