Abstract
Background and Aims
Sorafenib is a proven first-line treatment recommended for hepatocellular carcinoma (HCC) patients with portal vein invasion (PVI). However, multiple treatment modalities are used in clinical practice as a first-line option. This study is a prospective, observational, multicenter, cohort study evaluating patterns of treatment modalities and outcomes for HCC patients with PVI.
Methods
The baseline characteristics, treatment modalities, and outcomes were prospectively collected for 287 newly diagnosed HCC patients with PVI between August 2015 and July 2016 from 16 sites in Korea.
Results
During a median 7.8 months of follow-up (range 0.3–24.6 months), mortality was observed in 123 (42.9%) patients. Decision tree analysis classified patients into five subgroups with different outcomes. The patterns of treatment were very heterogeneous, and there was no dominant treatment modality. The most commonly used treatment modality was transarterial chemoembolization (TACE) (20.2%) followed by TACE plus external beam radiation therapy (17.8%) and sorafenib (12.5%). When stratified according to the extent of PVI, sorafenib treatment showed comparable outcomes when the PVI extent was lobal or main/bilateral, yet showed worse outcomes when the PVI extent was limited to the segmental level compared to those who received treatment other than sorafenib.
Conclusions
HCC patients with PVI comprise a heterogeneous population and are treated with various treatment modalities with diverse clinical outcomes in clinical practice. Subclassification of HCC patients with PVI is required to minimize heterogeneity and should be considered for the selection of treatment modalities and future clinical trials.
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Abbreviations
- PVI:
-
Portal vein invasion
- HCC:
-
Hepatocellular carcinoma
- BCLC:
-
Barcelona Clinic Liver Cancer
- TACE:
-
Transarterial chemoembolization
- HAIC:
-
Hepatic arterial infusion chemotherapy
- AFP:
-
Alpha-fetoprotein
- EBRT:
-
External beam radiation therapy
- AUROC:
-
Area under the receiver operating characteristic
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Funding
This study was supported in part by the Korean Liver Cancer Association 2016 study grant.
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Sinn, D.H., Lee, H.W., Paik, YH. et al. Patterns and Outcomes in Hepatocellular Carcinoma Patients with Portal Vein Invasion: A Multicenter Prospective Cohort Study. Dig Dis Sci 66, 315–324 (2021). https://doi.org/10.1007/s10620-020-06134-4
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DOI: https://doi.org/10.1007/s10620-020-06134-4