The impact of portal vein tumor thrombosis on survival in patients with hepatocellular carcinoma treated with different therapies: A cohort study

Autor: Christoph Düber, Aline Mähringer-Kunz, Roman Kloeckner, Irene Schmidtmann, Peter R. Galle, Jan B. Hinrichs, Arndt Weinmann, Verena Steinle, Felix Hahn, Hauke Lang, Sebastian Schotten
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
medicine.medical_treatment
viruses
Cancer Treatment
Cardiovascular Medicine
Vascular Medicine
Diagnostic Radiology
Cohort Studies
0302 clinical medicine
Medical Conditions
Medicine and Health Sciences
Medicine
Venous Thrombosis
Multidisciplinary
Portal Vein
Liver Diseases
Radiology and Imaging
Selective internal radiation therapy
Liver Neoplasms
Hematology
Middle Aged
Tumor Resection
Thrombosis
Magnetic Resonance Imaging
Treatment Outcome
Surgical Oncology
Oncology
Cardiovascular Diseases
030220 oncology & carcinogenesis
Hepatocellular carcinoma
030211 gastroenterology & hepatology
Female
Radiology
Anatomy
Liver cancer
medicine.drug
Research Article
Hepatic Resection
Sorafenib
Adult
Clinical Oncology
medicine.medical_specialty
Carcinoma
Hepatocellular
Imaging Techniques
Science
Cardiology
Radiation Therapy
Surgical and Invasive Medical Procedures
Gastroenterology and Hepatology
Research and Analysis Methods
Veins
03 medical and health sciences
Digestive System Procedures
Diagnostic Medicine
Gastrointestinal Tumors
Humans
Chemoembolization
Therapeutic
Portal Veins
Blood Coagulation
Aged
Retrospective Studies
Surgical Resection
Coagulation Disorders
business.industry
Proportional hazards model
Carcinoma
Cancers and Neoplasms
Biology and Life Sciences
Hepatocellular Carcinoma
medicine.disease
Survival Analysis
Radiation therapy
Cardiovascular Anatomy
Blood Vessels
Clinical Medicine
business
Complication
Zdroj: PLoS ONE, Vol 16, Iss 5, p e0249426 (2021)
PLoS ONE
ISSN: 1932-6203
Popis: Background Portal vein tumor thrombosis (PVTT) is a frequent complication of hepatocellular carcinoma (HCC), which leads to classification as advanced stage disease (regardless of the degree of PVTT) according to the Barcelona Clinic Liver Cancer Classification. For such patients, systemic therapy is the standard of care. However, in clinical reality, many patients with PVTT undergo different treatments, such as resection, transarterial chemoembolization (TACE), selective internal radiation therapy (SIRT), or best supportive care (BSC). Here we examined whether patients benefited from such alternative therapies, according to the extent of PVTT. Methods This analysis included therapy-naïve patients with HCC and PVTT treated between January 2005 and December 2016. PVTT was classified according to the Liver Cancer study group of Japan as follows: Vp1 = segmental PV invasion; Vp2 = right anterior or posterior PV; Vp3 = right or left PV; Vp4 = main trunk. Overall survival (OS) was analyzed for each treatment subgroup considering the extent of PVTT. We performed Cox regression analysis with adjustment for possible confounders. To further attenuate selection bias, we applied propensity score weighting using the inverse probability of treatment weights. Results A total of 278 treatment-naïve patients with HCC and PVTT were included for analysis. The median observed OS in months for each treatment modality (resection, TACE/SIRT, sorafenib, BSC, respectively) was 32.4, 8.1, N/A, and 1.7 for Vp1; 10.7, 6.9, 5.5, and 1.2 for Vp2; 6.6, 7.5, 2.9, and 0.6 for Vp3; and 8.0, 3.6, 5.3, and 0.7 for Vp4. Thus, the median OS in the resection group in case of segmental PVTT (Vp1) was significantly longer compared to any other treatment group (all p values Conclusions Treatment strategy for HCC with PVTT should not be limited to systemic therapy in general. The extent of PVTT should be considered when deciding on treatment alternatives. In patients with segmental PVTT (Vp1), resection should be evaluated.
Databáze: OpenAIRE
Externí odkaz: