title: Prognostic factors for patients with hepatocellular carcinoma with macroscopic portal vein or inferior vena cava tumor thrombi receiving external-beam radiation therapy.
abstract: Prognostic factors in patients with hepatocellular carcinoma (HCC) with tumor thrombosis are not well established, especially for those given external-beam radiation therapy (EBRT). Patients (n = 136) with HCC who had portal vein (PV) or inferior vena cava (IVC) tumor thrombus received EBRT between January 1998 and October 2007. Demographic variables, laboratory values, tumor characteristics, and treatment modalities were determined at diagnosis and before EBRT. The total radiation dose ranged from 30 to 60 Gy (median, 50 Gy) and was focused on the tumor thrombi. Predictors of survival were identified using the univariate and multivariate analysis. Of the 136 patients, the tumor thrombus completely disappeared in 41 patients (30.1%), 36 patients (26.5%) had a partial response, 49 patients (36%) had stable disease, and 10 patients (7.4%) had progressive disease. On multivariate analysis, pretreatment unfavorable predictors were associated with lower albumin, higher gamma-glutamyltransferase and alpha-fetoprotein levels, poorer Child-Pugh classification, intrahepatic multifocality, lymph node metastases, poorer response to EBRT, and 2-dimension EBRT technique. Survival rates at 1, 2, and 3 years were 31.8%, 17.5%, and 8.8% for patients with PV tumor thrombi; 66.3%, 21.1%, and 15.8% for IVC tumor thrombi; and 25%, 8.3%, and 0% for PV plus IVC tumor thrombi, respectively. Overall median survival was 9.7 months. This study provides detailed information about the survival outcomes and prognostic factors of HCC with tumor thrombi in a relatively large cohort of patients treated with radiation, and the results will help in understanding the potential factors that influence survival for patients with HCC after EBRT.
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 136 Yi Xue Road, Shanghai 200032, China. zeng.zhaochong@zs-hospital.sh.cn
authors.forename: Zhao-Chong
authors.initials: ZC
authors.lastname: Zeng
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
authors.forename: Zhao-You
authors.initials: ZY
authors.lastname: Tang
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Wang
authors.forename: Bin-Liang
authors.initials: BL
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002648:Child; D015331:Cohort Studies; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D011169:Portal Vein / Q000473:pathology*; D011379:Prognosis; D016019:Survival Analysis; D013927:Thrombosis / Q000150:complications* / Q000473:pathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology*; D055815:Young Adult