4.3 Article

Treatment of Naive HCC Combined with Segmental or Subsegmental Portal Vein Tumor Thrombosis: Liver Resection Versus TACE Followed by Radiotherapy

Journal

ANTICANCER RESEARCH
Volume 38, Issue 8, Pages 4919-4925

Publisher

INT INST ANTICANCER RESEARCH
DOI: 10.21873/anticanres.12808

Keywords

HCC; radiation therapy; surgery; TACE; thrombosis

Categories

Funding

  1. Basic Science Research Program through the National Research Foundation of Korea (NRF) - Ministry of Education [NRF-2017R1D1A1B03031275]
  2. Marine Biotechnology Program - Ministry of Oceans and Fisheries, Korea [20150220]

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Background/Aim: There is no definite consensus regarding management of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). This study aimed to compare clinical outcomes according to initial treatment modality for treatment of naive HCC combined with subsegmental (Vp1)/ segmental (Vp2) PVTT with liver resection (LR) versus trans-arterial chemoembolization (TACE) followed by radiotherapy (RT). Materials and Methods: From our institutional registry, we enrolled 78 patients diagnosed with HCC combined with Vp1 or Vp2 PVTT and treated with LR or TACE followed by RT (TACE-RT) as a primary treatment. Results: LR was more frequently applied for younger, nodular tumor morphology, or solitary tumor. Overall, LR yielded significantly better progression free survival (PFS) (p=0.02, 41.9% vs. 15.7% at 2-years), and marginally higher overall survival (OS) (p=0.09, 75.8% vs. 61.5% at 2-years). There was an interaction effect between primary treatment and tumor morphology, and a significantly higher PFS was observed after LR in nodular morphology, in contrast with the lower PFS that was achieved after LR in infiltrative or massive morphology. Conclusion: Although LR yielded higher PFS than TACE-RT in HCC with Vp1 or Vp2 PVTT with similar acute complications, the difference in PFS between the LR and TACE-RT groups was significantly affected by tumor morphology.

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