Purpose: To evaluate the safety and efficacy of transarterial chemoembolization and to identify the prognostic factors associated with survival in patients with hepatocellular carcinoma (HCC) and portal vein (PV) invasion.
Materials and methods: From January 2006 to March 2012, 50 patients with HCC invading into the PV (Barcelona Clinic Liver Cancer stage C) were treated with transarterial chemoembolization. The parenchymal tumor and PV tumor were confirmed by multidetector computed tomography (CT) and angiography. There were 14 patients with right PV tumor, 12 patients with left PV tumor, and 24 patients with main PV tumor. The response was evaluated by multidetector CT using Response Evaluation Criteria in Solid Tumors. Patients with residual tumors received repeated transarterial chemoembolization every 6-8 weeks unless the patients achieved complete remission or developed contraindications.
Results: The median survival period of the entire group was 6.2 months (range, 1.7-50.9 mo), and the overall response rate was 42% (21 of 50 patients). The 6-month, 12-month, 24-month, and 36-month survival rates were 54%, 22%, 10%, and 8%. There were no instances of 30-day mortality or acute liver failure related to transarterial chemoembolization. The median survival of the 21 responders was 10.5 months, and the median survival of the 29 nonresponders was 5.5 months (P < .001). In both univariate and multivariate analyses, only the response to transarterial chemoembolization (hazard ratio = 0.25, P < .001) and the absence of ascites (hazard ratio = 0.24, P = .01) were significant prognostic factors.
Conclusions: Transarterial chemoembolization is a safe and effective treatment for HCC with major PV invasion. The response to transarterial chemoembolization and the ascites status were the most significant predictive factors for prolonged survival.
Keywords: BCLC; Barcelona Clinic Liver Cancer; ECOG; Eastern Cooperative Oncology Group; HCC; PV; PVA; hepatocellular carcinoma; polyvinyl alcohol; portal vein.
© 2013 The Society of Interventional Radiology Published by SIR All rights reserved.