title: Transcatheter arterial chemoembolization for advanced hepatocellular carcinoma with portal vein invasion: safety, efficacy, and prognostic factors.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Radiology, Sun Yat-Sen Cancer Center, 125 Li-der Road, Bei-Tou District, Taipei, Taiwan. Electronic address: mcchern@hotmail.com.tw.
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Chern
authors.affiliation: Department of Radiology, Sun Yat-Sen Cancer Center, 125 Li-der Road, Bei-Tou District, Taipei, Taiwan.
authors.forename: Vincent P
authors.initials: VP
authors.lastname: Chuang
authors.affiliation: Department of Radiology, Sun Yat-Sen Cancer Center, 125 Li-der Road, Bei-Tou District, Taipei, Taiwan.
authors.forename: Chung-Ting
authors.initials: CT
authors.lastname: Liang
authors.affiliation: Department of Radiology, Sun Yat-Sen Cancer Center, 125 Li-der Road, Bei-Tou District, Taipei, Taiwan.
authors.forename: Z H
authors.initials: ZH
authors.lastname: Lin
authors.affiliation: Department of Radiology, Sun Yat-Sen Cancer Center, 125 Li-der Road, Bei-Tou District, Taipei, Taiwan.
authors.forename: Tse-Ming
authors.initials: TM
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000098:blood supply / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: BCLC; Barcelona Clinic Liver Cancer; ECOG; Eastern Cooperative Oncology Group; HCC; PV; PVA; hepatocellular carcinoma; polyvinyl alcohol; portal vein