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Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus
Article first published online: 22 FEB 2012
Copyright © 2012 American Cancer Society
Volume 118, Issue 19, pages 4725–4736, 1 October 2012
How to Cite
Peng, Z.-W., Guo, R.-P., Zhang, Y.-J., Lin, X.-J., Chen, M.-S. and Lau, W. Y. (2012), Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus. Cancer, 118: 4725–4736. doi: 10.1002/cncr.26561
- Issue published online: 19 SEP 2012
- Article first published online: 22 FEB 2012
- Manuscript Accepted: 12 AUG 2011
- Manuscript Revised: 11 JUL 2011
- Manuscript Received: 20 MAY 2011
- hepatic resection;
- transcatheter arterial chemoembolization;
- hepatocellular carcinoma;
- portal vein tumor thrombus;
- overall survival;
- disease-free survival
The long-term survival outcomes of hepatic resection (HR) compared with transcatheter arterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) are unclear.
MATERIALS AND METHODS:
Between December 2002 and December 2007, 201 consecutive patients diagnosed with resectable HCC with PVTT received HR as an initial treatment in our center. These patients were compared with 402 case-matched controls selected from a pool of 1798 patients (with a 1:2 ratio) who received TACE as an initial treatment during the study period. PVTT was classified to 4 types: PVTT involving the segmental branches of the portal vein or above (type I), PVTT extending to involve the right/left portal vein (type II), the main portal vein (type III), or the superior mesenteric vein (type IV).
The 1-, 3-, and 5-year overall survivals for the HR and TACE groups were 42.0%, 14.1%, and 11.1% and 37.8%, 7.3%, and 0.5%, respectively (P < .001). On subgroup analyses, the overall survivals for the HR group were better than the TACE group for type I PVTT, type II PVTT, single tumor, and tumor size >5 cm (P < .001, P = .002, P < .001, P < .001, respectively), but not for type III PVTT, type IV PVTT, multiple tumors, and tumor size <5 cm (P = .541, P = .371, P = .264, P = .338, P = .125, respectively). Multivariate analysis showed the type of PVTT and initial treatment allocation were significant prognostic factors for overall survival.
Compared with TACE, HR provided survival benefits for patients with resectable HCC with PVTT, especially for those with a type I PVTT or a type II PVTT. Cancer 2012. © 2012 American Cancer Society.