Published online Apr 7, 2021. doi: 10.3748/wjg.v27.i13.1330
Peer-review started: January 9, 2021
First decision: February 11, 2021
Revised: February 19, 2021
Accepted: March 7, 2021
Article in press: March 7, 2021
Published online: April 7, 2021
Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) have poor prognosis. Transarterial chemoembolization (TACE) is an effective treatment for HCC patients with PVTT. The factors affecting the short-term and long-term prognosis of HCC patients with PVTT receiving TACE are still unclear.
The main aim of this study was to clarify the predictors correlated with the short-term and long-term survival of HCC patients with PVTT who underwent TACE.
We can provide some guidance to clinicians for selecting suitable patients for TACE by analyzing preoperative indicators.
A total of 181 HCC patients with PVTT who underwent TACE were enrolled in this retrospective study. We explored the short-term and long-term prognostic factors by comparing the preoperative indicators of patients who died and survived within 3 mo and 12 mo after TACE. Multivariate analyses were conducted using logistic regression. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of the factors related to the short-term and long-term prognosis.
Total bilirubin, sex, and aspartate aminotransferase (AST) were closely linked to short-term survival. When AST ≥ 87 U/L and total bilirubin ≥ 16.15 µmol/L, the 3-mo survival rate after TACE was reduced significantly. In long-term survival analysis, we found that patients with only one lesion had better long-term survival than those with ≥ three lesions. Patients with massive block liver cancer had a worse long-term outcome than patients with nodular and diffuse liver cancer.
Sex, AST, and total bilirubin were associated with short-term survival outcomes in HCC patients with PVTT who underwent TACE. According to the area under the curve, AST was the best predictor of short-term survival, followed by total bilirubin. Multiple tumor lesions and massive block types of liver cancer were closely related to long-term adverse survival outcomes in HCC patients with PVTT who underwent TACE.
Larger and multicenter studies are needed to validate further the results in the future.