title: Multimodality Treatment for Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Large-Scale, Multicenter, Propensity Mathching Score Analysis.
abstract: The optimal treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) remains controversial. We aimed to investigate the best treatment for patients with HCC with PVTT. From January 2002 to January 2014, the data from all consecutive patients with HCC with PVTT who underwent surgical treatment (ST),TACE,TACE combined with sorafenib (TACE-Sor), or TACE combined with radiotherapy (TACE-RT) in the 4 largest tertiary hospitals in China were analyzed retrospectively. The patients were divided into 3 subtypes according to the extent of PVTT in the portal vein (type I-III). The primary endpoint was overall survival (OS). A total of 1580 patients with HCC with PVTT were included in the study. The median survival times (MST) for ST (n = 745) for type I, II, and III patients (95% CI) were 15.9 (13.3-18.5), 12.5 (10.7-14.3), and 6.0 (4.3-7.7) months, respectively. The corresponding figures for patients after TACE (n = 604) were 9.3 (5.6-12.9), 4.9 (4.1-5.7), and 4.0 (3.1-4.9), respectively; for patients after TACE-Sor (n = 113) 12.0 (6.6-17.4), 8.9 (6.7-11.1), and 7.0 (3.0-10.9), respectively; and for patients after TACE-RT (n = 118) 12.2 (0-24.7), 10.6 (6.8-14.5), and 8.9 (5.2-12.6), respectively. Comparison among the different treatments for the 3 subtypes of PVTT patients after propensity score (PS) matching showed the effectiveness of ST to be the best for type I and type II PVTT patients, and TACE-RT was most beneficial for type III patients. Treatment was an independent risk factor of OS. ST was the best treatment for type I and II PVTT patients with Child-Pugh A and selected B liver function. TACE-RT should be given to type III PVTT patients.
authors.affiliation: From the Department of Hepatic Surgery (KW, WXG, JS, MCW, WYL, SQC), Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai; Faculty of Medicine (WYL), The Chinese University of Hong Kong, Shatin, Hong Kong SAR; Department of Hepatobiliary Surgery (MSC, YJZ), SunYat-sen University Cancer Center; Department of Liver Surgery (YLM), Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing; Liver Transplantation Center of the First Affiliated Hospital (BCS), Nanjing Medical University, Nanjing, Jiangsu Province; Department of Radiotherapy (YM); Department of Invasive Technology (YFY); and Department of Pathology (WMC), Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Kang
authors.initials: K
authors.lastname: Wang
authors.forename: Wei Xing
authors.initials: WX
authors.lastname: Guo
authors.forename: Min Shan
authors.initials: MS
authors.lastname: Chen
authors.forename: Yi Lei
authors.initials: YL
authors.lastname: Mao
authors.forename: Bei Cheng
authors.initials: BC
authors.lastname: Sun
authors.forename: Jie
authors.initials: J
authors.lastname: Shi
authors.forename: Yao Jun
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Yan
authors.initials: Y
authors.lastname: Meng
authors.forename: Ye Fa
authors.initials: YF
authors.lastname: Yang
authors.forename: Wen Ming
authors.initials: WM
authors.lastname: Cong
authors.forename: Meng Chao
authors.initials: MC
authors.lastname: Wu
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
authors.forename: Shu Qun
authors.initials: SQ
authors.lastname: Cheng
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D002681:China / Q000453:epidemiology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D011169:Portal Vein; D057216:Propensity Score; D011878:Radiotherapy; D012189:Retrospective Studies; D000077157:Sorafenib; D020246:Venous Thrombosis / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib