Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2016; 22(13): 3632-3643
Published online Apr 7, 2016. doi: 10.3748/wjg.v22.i13.3632
Comprehensive treatments for hepatocellular carcinoma with tumor thrombus in major portal vein
Hai-Hong Ye, Jia-Zhou Ye, Zhi-Bo Xie, Yu-Chong Peng, Jie Chen, Liang Ma, Tao Bai, Jun-Ze Chen, Zhan Lu, Hong-Gui Qin, Bang-De Xiang, Le-Qun Li
Hai-Hong Ye, Department of Hepatobiliary Surgery, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China
Jia-Zhou Ye, Yu-Chong Peng, Jie Chen, Liang Ma, Tao Bai, Jun-Ze Chen, Zhan Lu, Hong-Gui Qin, Bang-De Xiang, Le-Qun Li, Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Zhi-Bo Xie, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
Author contributions: Ye HH and Ye JZ contributed equally to this work, consider as co-first author; Li LQ and Ye HH contributed to the study concept and design; Ye HH and Xie ZB contributed to the data acquisition; Ye HH, Peng YC, Chen JZ and Xie ZB contributed to the data analysis and interpretation; Ye HH, Peng YC, Ye JZ and Xie ZB contributed to the drafting of the manuscript; Ye HH, Peng YC, Ye JZ, Chen J, Ma L, Bai T and Xie ZB contributed to critical revision of the manuscript for important intellectual content; Ye HH and Li LQ provided the funding; Ye JZ and Xie ZB contributed to the administrative, technical, or material support; Ye JZ, Peng YC and Xie ZB supervised the study.
Supported by National Major Special Science and Technology Project, No. 2012ZX10002010001009.
Institutional review board statement: The study was reviewed and approved by the Affiliated Tumor Hospital of Guangxi Medical University Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors disclose no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Le-Qun Li, MD, Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, No. 71 Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. lequn_li001@163.com
Telephone: +86-771-5330855 Fax: +86-771-5312000
Received: October 24, 2015
Peer-review started: October 25, 2015
First decision: November 27, 2015
Revised: December 30, 2015
Accepted: January 18, 2016
Article in press: January 18, 2016
Published online: April 7, 2016
Abstract

AIM: To evaluate the efficacy of transcatheter arterial chemoembolisation (TACE) compared with surgical intervention and sorafenib for treatment of hepatocellular carcinoma (HCC) in patients with tumor thrombus extending to the main portal vein.

METHODS: From 2009 to 2013, a total of 418 HCC patients with tumor thrombus extending to the main portal vein were enrolled in this study and divided into four groups. These groups underwent different treatments as follows: TACE (n = 307), surgical intervention (n = 54), sorafenib (n = 15) and palliative treatment (n = 42). Overall survival rates were determined by Kaplan-Meier method, and differences between the groups were identified through log-rank analysis. Cox’s proportional hazard model was used to identify the risk factors for survival.

RESULTS: The mean survival periods for patients in the TACE, surgical intervention, sorafenib and palliative treatment groups were 10.39, 4.13, 5.54 and 2.82 mo, respectively. For the TACE group, the 3-, 6-, 12- and 24-mo survival rates were 94.1%, 85.9%, 51.5% and 0.0%, respectively. The corresponding rates were 60.3%, 22.2%, 0.0% and 0.0% for the surgical intervention group and 50.9%, 29.5%, 0.0% and 0.0% for the sorafenib group. Evidently, the results in the TACE group were significantly higher than those in the other groups (P < 0.0001). Furthermore, no significant difference among survival rates was observed between TACE with/without sorafenib (10.22 mo vs 10.52 mo, P = 0.615). No significant difference in survival rates was also found among the surgical intervention, sorafenib and palliative treatment groups (P > 0.05). These values significantly increased after TACE with/without sorafenib compared with other treatments (P < 0.05).

CONCLUSION: For HCC patients with tumor thrombus extending to the main portal vein, TACE can yield a higher survival rate than surgical intervention or sorafenib treatment.

Keywords: Hepatocellular carcinoma, Portal vein, Tumor thrombus, Sorafenib, Transcatheter arterial chemoembolisation, Surgery

Core tip: This study evaluated the efficacy of transcatheter arterial chemoembolisation (TACE) compared with surgical intervention and sorafenib for treatment of hepatocellular carcinoma (HCC) in patients with tumor thrombus extending to the main portal vein. Results revealed that for HCC patients with tumor thrombus extending to the main portal vein, TACE can yield a higher survival rate than surgical intervention or sorafenib treatment.