Abstract
To compare the efficacy and complication rates of locoregional therapies (LRT) versus systemic therapy (ST) for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT). Following local institutional review board approval, we reviewed all HCC patients with PVTT treated at a single institution between 2005 and 2018. Baseline patient demographics, comorbidities, severity of liver disease, as well as tumor and treatment characteristics were compared between groups using Chi-squared or Student’s t-test. Overall survival (OS) and progression-free survival (PFS) were compared between groups using the log-rank test. Complications were assessed and graded per Society of Interventional Radiology (SIR) guidelines and compared using Chi-squared test. 17 HCC patients with PVTT were identified, 10 of whom received LRT and 7 who received ST. LRT patients received transarterial chemoembolization (TACE, 20%), transarterial radioembolization (TARE, 30%), and bland transarterial embolization (TAE, 50%). ST patients all received sorafenib. There were no significant differences between the LRT and ST groups in basic demographics, medical comorbidities, history of other malignancy, tumor characteristics, liver disease or performance status (table). Median OS was 444 days for the LRT group and 1147 days for the ST group (P = 0.7). Median PFS was 83 days following LRT and 67 days following ST (P = 0.3). Complication rates did not differ significantly between LRT and ST groups (50% vs. 28.6%, P = 0.62). In this comparative study, there were no significant differences in OS, PFS, or complications for HCC patients with PVTT receiving LRT versus ST. Additional larger, prospective studies are needed to further assess survival benefit and complication rates between these treatment modalities for this difficult-to-treat population.Tabled 1LRTSTP valueAge (yrs)63.5620.53Gender (% female)4028.61.00Diabetes Mellitus (%)1042.90.25Heart Disease (%)3000.23Other Malignancy History (%)2000.49Largest Tumor Diameter (cm)5.98.20.35Extrahepatic Disease (%)2028.61.00Child-Pugh Score (% C)028.60.28ECOG Performance Score (% stage 0)6028.60.53 Open table in a new tab
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