Chemotherapeutic perfusion of portal vein after tumor thrombectomy and hepatectomy benefits patients with advanced hepatocellular carcinoma: A propensity score-matched survival analysis.

BACKGROUND: Portal vein tumor thrombus (PVTT) is a common complication in hepatocellular carcinoma (HCC), signaling dismal outcomes. This study was conducted to evaluate the survival benefit of postoperative portal vein perfusion chemotherapy (PVC) in patients with HCC and PVTT. METHODS: A retrospective review was conducted in 401 consecutive patients with HCC and PVTT who underwent hepatic resection between January 2009 and December 2015 and 67 patients received adjuvant postoperative PVC. A propensity score matching (PSM) was used to match patients with and without PVC at a ratio of 1:1. RESULTS: After PSM, the median time to recurrence (TTR) and overall survival (OS) were significantly longer in PVC group compared with control group (12.3 vs 5.8 months, P = .001; 19.0 vs 13.4 months, P = .037; respectively). At 1, 2, 3, and 5 years, the cumulative recurrence rates in PVC group were 48.1%, 86.5%, 92.3% ,96.2%, respectively, with OS rates of 63.8%, 37.9%, 24.4%, 18.3%, respectively; whereas cumulative recurrence rates of 76.6%, 91.5%, 94.3%, and 97.2%, respectively and OS rates of 55.4%, 23.0%, 12.4%, and 12.4%, respectively were recorded for the control group. In multivariate analysis, postoperative PVC emerged as a significant predictor for TTR (hazard ratio [HR], 0.523; P = .001) and OS (HR, 0.591; P = .010). PVC could reduce early recurrence (≤1 year) rate after surgical resection (40.3% vs 64.2%, P = .006) and clinical outcomes were further enhanced by adding sorafenib to postoperative PVC. CONCLUSIONS: Compared with surgical resection alone, postoperative adjuvant PVC treatment boosts survival and reduces early tumor recurrences in patients surgically treated for HCC and PVTT.

Recurrent hepatocellular carcinoma after partial hepatectomy: treatment with repeat hepatectomy,followed by transcatheter arterial chemoembolization and percutaneous microwave coagulation therapy but with or without portal vein chemotherapy / 中华肝胆外科杂志

Objective To study the results of repeat hepatectomy,followed by transcatheter arterial chemoembolization (TACE) and percutaneous microwave coagulation therapy (PMCT),but with or without portal vein chemotherapy (PVC) in patients with recurrence of hepatocelluar carcinoma (HCC) after partial hepatectomy.Methods The data of 33 patients were analyzed retrospectively.All these patients received repeat hepatectomy.They were then divided into two groups:the PVC group (n =19) was treated with PVC + TACE + PMCT,and the non-PVC group (n =14) with TACE + PMCT.Results For the 33 patients,13 (39.4％) developed tumor recurrence ＞2 years from the initial resection while 20 patients (60.6％) developed recurrence within ≤ 2 years.The tumor recurrence consisted of local recurrence in 14 patients (42.4％),and heterochronous recurrence in 19 patients (57.6％).There was a significantly difference in the cumulative survival rates between the two groups (x2 =4.319; P =0.038).The 1y,3y,5y survival rates were 84.2％,42.1％,31.6％ in the PVC Group,and 71.4％,28.6％,14.3％ in the Non-PVC Group respectively.28 sessions of PMCT and 97 sessions of TACE were performed postoperatively (the medians were 1,0.5; 3,3 respectively,the mean ranks were 17.68,16.07; 15.05,19.64 respectively,and the P values were 0.612,0.163 respectively between the two groups).Conclusions For patients with recurrence of HCC after hepatic resection,after repeat hepatectomy PVC + TACE + PMCT gave better survival than those with TACE + PMCT but without PVC.

A 3-year-follow-up study on the prognosis of ‘two-route chemotherapy’ on liver cancer patients with portal vein tumor thrombus / 中华流行病学杂志

Objective To study the achievements and safety of Transcatheter arterial chemoembolization (TACE) associated Portal Vein Chemo-therapy (PVC) per-drug delivery system (DDS) program in preventing the recurrence of hepatic cell cancer (HCC) and Portal Vein Tumor Thrombus (PVTT).Methods 97 cases with HCC and PVTT were treated from Januay 2009 to January 2011.Patients with tumor or tumor thrombus were resected on all the cases and randomly divided into 3 groups.TACE,PVC per-DDS TACE and PVC per-DDS were given to group A,group B,and group C,respectively.Patients in the 3 groups were followed and compared on the Disease Free Survivals (DFS) and the accumulative survival rates,at 6 months,1 year and 2 years after the operation.Results After the surgery was completed in June,the 1-year,2-year,3-year survival rates and cummulative survival rate in group C was higher than in group A or group.Significant differences did no appeare in June but did show in 1 year after the surgery (P＞0.05) as well as in both 2 and 3 years,after the surgery (P＜0.01).Conclusion Patients with HCC and PVTT,the TACE chemotherapy in association with PVC per-DDS could increase both the DFSs and accumulative survival rates,when compared to the either single TACE or PVC per-DDS,after the tumor or tumor thrombus were resected.