title: Efficacy of transarterial chemoembolization targeting portal vein tumor thrombus in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  We aimed to retrospectively examine the tolerability and efficacy of transarterial chemoembolization (TACE) in patients with advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).
  
  
  METHODS
  Adverse events were assessed using the Common Terminology Criteria for Adverse Events, version 4.0. The efficacy of TACE in parenchymal tumors (parenchymal response) and PVTT (PVTT response) was separately evaluated by dynamic computed tomography 1 to 2 months after TACE according to the Response Evaluation Criteria in Cancer of the Liver (RECICL). Patients with complete remission plus partial response in parenchymal tumors and PVTT were assessed as parenchymal response-positive and PVTT response-positive, respectively.
  
  
  RESULTS
  A total of 33 HCC patients with PVTT were analyzed. Grade 3/4 toxicities included elevated aspartate aminotransferase levels (69.7%), elevated alanine aminotransferase levels (54.5%), hyponatremia (6.1%), thrombocytopenia (6.1%), hyperbilirubinemia (3.0%), leukopenia (3.0%) and anemia (3.0%). All these findings returned to the pre-treatment levels within 1 month after TACE. The number of parenchymal response-positive/negative and PVTT response-positive/negative patients was 20/13 and 13/20, respectively. Kaplan-Meier analyses revealed that the cumulative survival rate was significantly higher in parenchymal response-positive (p=0.04) and PVTT response-positive (p<0.01) patients than in their negative counterparts. PVTT response was a favorable prognostic factor for overall survival in multivariate analysis (p=0.03).
  
  
  CONCLUSIONS
  TACE was feasible in HCC patients with PVTT and could improve their survival by showing direct therapeutic effect against PVTT.
authors: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Akinobu
authors: A
authors: Tawada
authors: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan techiba@faculty.chiba-u.jp.
authors: Tetsuhiro
authors: T
authors: Chiba
authors: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Yoshihiko
authors: Y
authors: Ooka
authors: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Naoya
authors: N
authors: Kanogawa
authors: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Tenyu
authors: T
authors: Motoyama
authors: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Tomoko
authors: T
authors: Saito
authors: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Sadahisa
authors: S
authors: Ogasawara
authors: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Eiichiro
authors: E
authors: Suzuki
authors: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Hitoshi
authors: H
authors: Maruyama
authors: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Fumihiko
authors: F
authors: Kanai
authors: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Masaharu
authors: M
authors: Yoshikawa
authors: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors: Osamu
authors: O
authors: Yokosuka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology*; D020246:Venous Thrombosis / Q000628:therapy*
keywords: Hepatocellular carcinoma; portal vein tumor thrombus; prognosis; survival; transcatheter arterial chemoembolization