OUTCOMES OF TRANSARTERIAL CHEMOEMBOLIZATION IN HCC PATIENTS WITH SEGMENTAL PORTAL VEIN TUMOR THROMBOSIS
Main Article Content
Keywords
Hepatocellular carcinoma, portal vein tumor thrombosis, TACE, mRECIST, survival outcomes, liver cancer
Abstract
Hepatocellular carcinoma (HCC) complicated by portal vein tumor thrombosis (PVTT) carries a poor prognosis, with limited therapeutic options and reduced survival. Transarterial chemoembolization (TACE) is commonly used in patients with unresectable HCC; however, outcomes among those with segmental PVTT remain less clearly defined in many regions, including Pakistan. This study evaluates the therapeutic response, survival outcomes, and safety profile of TACE in HCC patients presenting with segmental PVTT.
Methods:
This prospective observational study included 80 patients with radiologically confirmed HCC and segmental PVTT who underwent TACE. Eligible patients had Child-Pugh A or B liver function and ECOG performance status ≤2. TACE was performed using Lipiodol-doxorubicin emulsion followed by Gelfoam embolization. Tumor response at 4–6 weeks post-procedure was assessed using mRECIST criteria. Survival outcomes were analyzed using Kaplan–Meier curves, and complications were recorded. A p-value <0.05 was considered statistically significant.
Results:
The cohort had a mean age of 58.7 ± 9.2 years, with males comprising 82.5%. Hepatitis C infection was the predominant etiology (71.3%). The objective response rate (CR + PR) was 58.8%, with complete response in 17.5% and partial response in 41.3% of patients. Median overall survival (OS) was 13.6 months, and median progression-free survival (PFS) was 8.9 months. Patients with Child-Pugh A had significantly better OS than those with Child-Pugh B (15.4 vs. 11.1 months; p = 0.021). Responders (CR + PR) demonstrated superior OS compared to non-responders (17.8 vs. 10.2 months; p < 0.001). Post-embolization syndrome occurred in 58.7% of patients, while major complications were infrequent, including hepatic failure (5%) and liver abscess (2.5%). No peri-procedural mortality was observed.
Conclusion:
TACE provides a favorable therapeutic response and acceptable safety profile in HCC patients with segmental PVTT, offering meaningful survival benefits, especially among those with better baseline liver function. Objective responders and Child-Pugh A patients demonstrated significantly improved outcomes, reaffirming the value of careful patient selection.
References
1. Patıdar Y., Mukund A., & Sarin S..Transarterial chemoembolization in unresectable hepatocellular carcinoma with portal vein tumor thrombosis: a tertiary care center experience. Indian Journal of Radiology and Imaging 2021;31(02):270-276. https://doi.org/10.1055/s-0041-1734367
2. Falette-Puisieux M., Nault J., Bouattour M., Lequoy M., Amaddeo G., Decaens T.et al. Beyond atezolizumab plus bevacizumab in patients with advanced hepatocellular carcinoma: overall efficacy and safety of tyrosine kinase inhibitors in a real-world setting. Therapeutic Advances in Medical Oncology 2023;15. https://doi.org/10.1177/17588359231189425
3. Hasegawa K., Takemura N., Yamashita T., Watadani T., Kaibori M., Kubo S.et al.. Clinical practice guidelines for hepatocellular carcinoma: the Japan Society of Hepatology 2021 version (5th JSH-HCC guidelines). Hepatology Research 2023;53(5):383-390. https://doi.org/10.1111/hepr.13892
4. Li L., Huang X., Cheng N., Weng X., Jiao Y., Liu J.et al.. Efficacy and safety of endovascular brachytherapy combined with transarterial chemoembolization for the treatment of hepatocellular carcinoma patients with type III-IV portal vein tumor thrombosis. 2021. https://doi.org/10.21203/rs.3.rs-952408/v1
5. Zhou T., Chen S., Wang H., Weng S., Zhou G., Zhang Y.et al.. Safety and efficacy of drug-eluting bead transarterial chemoembolization with callispheres® microspheres for hepatocellular carcinoma with portal vein tumor thrombus: a preliminary study. Journal of Cancer 2021;12(15):4522-4529. https://doi.org/10.7150/jca.54650
6. El-Araby A., Al-Alfy M., Habila M., & Shaheen M. Epidermal growth factor as a biomarker for early detection of hepatocellular carcinoma. Al-Azhar International Medical Journal 2022;0(0):0-0. https://doi.org/10.21608/aimj.2022.142492.1966
7. Chang Y., Jeong S., Jang J., & Kim Y.. Recent updates ontransarterialchemoembolization in hepatocellular carcinoma. International Journal of Molecular Sciences 2020;21(21):8165. https://doi.org/10.3390/ijms21218165
8. Kashfi S., Murdakhayev E., Rehmani R., & Sharma S.. Post-embolization syndrome complicated by hypertensive emergency and severely elevated transaminases. Cureus 2021. https://doi.org/10.7759/cureus.15446
9. Zou X., Xu Q., You R., & Yin G. Correlation and efficacy of tace combined with lenvatinib plus PD-1 inhibitor in the treatment of hepatocellular carcinoma with portal vein tumor thrombus based on immunological features. Cancer Medicine 2023;12(10):11315-11333. https://doi.org/10.1002/cam4.5841
10. Cheng A., Qin S., Ikeda M., Galle P., Ducreux M., Kim T.et al. Updated efficacy and safety data from imbrave150: atezolizumab plus bevacizumab vs. sorafenib for unresectable hepatocellular carcinoma. Journal of Hepatology 2022;76(4):862-873. https://doi.org/10.1016/j.jhep.2021.11.030
11. Asano K., Kageyama K., Yamamoto A., Jogo A., Nakano M., Murai K.et al.. Predictors of immediate deterioration of the Child-Pugh classification from A to B after transcatheter arterial chemo‐embolization for treatment‐naive hepatocellular carcinoma. Cancer Medicine 2024;13(21). https://doi.org/10.1002/cam4.70367
12. Ghrewati M., Mahmoud A., Beliani T., Keegan S., & Kumar M. Tumor thrombus of hepatocellular carcinoma: a direct extension from the liver to the right atrium. Cureus 2024. https://doi.org/10.7759/cureus.55158
13. Patıdar Y., Mukund A., & Sarin S..Transarterial chemoembolization in unresectable hepatocellular carcinoma with portal vein tumor thrombosis: a tertiary care center experience. Indian Journal of Radiology and Imaging 2021;31(02):270-276. https://doi.org/10.1055/s-0041-1734367
14. Huang Y., Zhang Z., Liao W., Hu K., & Wang Z.. Combination of sorafenib, camrelizumab, transcatheter arterial chemoembolization, and stereotactic body radiation therapy as a novel downstaging strategy in advanced hepatocellular carcinoma with portal vein tumor thrombus: a case series study. Frontiers in Oncology 2021;11. https://doi.org/10.3389/fonc.2021.650394
15. Ding X., Sun W., Chen J., Li W., Shen Y., Guo X.et al.. Percutaneous radiofrequency ablation combined with transarterial chemoembolization plus sorafenib for large hepatocellular carcinoma invading the portal venous system: a prospective randomized study. Frontiers in Oncology 2020;10. https://doi.org/10.3389/fonc.2020.578633
16. Tang Q., Huang W., Liang J., & Xue J. Efficacy and safety of transarterial chemoembolization in elderly patients of advanced hepatocellular carcinoma with portal vein tumor thrombus: a retrospective study. Frontiers in Oncology 2021;11. https://doi.org/10.3389/fonc.2021.646410
17. Zhou T., Chen S., Wang H., Weng S., Zhou G., Zhang Y.et al.. Safety and efficacy of drug-eluting bead transarterial chemoembolization with callispheres® microspheres for hepatocellular carcinoma with portal vein tumor thrombus: a preliminary study. Journal of Cancer 2021;12(15):4522-4529. https://doi.org/10.7150/jca.54650
18. Chen P., Chiu S., Tsai M., Chang K., Chang W., Lin H.et al.. Combination therapy of sorafenib and drug-eluting bead transarterial chemoembolization for advanced hepatocellular carcinoma with and without hepatic arteriovenous shunt. Journal of the Chinese Medical Association 2022;85(4):491-499. https://doi.org/10.1097/jcma.0000000000000696
19. Chen K. and Gao J. Factors influencing the short-term and long-term survival of hepatocellular carcinoma patients with portal vein tumor thrombosis who underwent chemoembolization. World Journal of Gastroenterology 2021;27(13):1330-1340. https://doi.org/10.3748/wjg.v27.i13.1330
20. Zhao Y., Shu-wei W., Xue Y., Dang Z., Nan Z., Wang D., et al.Transarterial chemoembolization combined with lenvatinib plus tislelizumab for unresectable hepatocellular carcinoma: a multicenter cohort study. Frontiers in Immunology 2024;15. https://doi.org/10.3389/fimmu.2024.1449663
21. Cai M., Liang L., Zhang J., Chen N., Huang W., Guo Y., et al. Lenvatinib plus drug-eluting bead transarterial chemoembolization with/without hepatic arterial infusion chemotherapy for hepatocellular carcinoma larger than 7 cm with major portal vein tumor thrombosis: a multicenter retrospective cohort study. International Journal of Surgery 2024;110(12):7860-7870. https://doi.org/10.1097/js9.0000000000001819
22. Liu B., Gao S., Zhu X., Guo J., Kou F., Liu S.et al.. Combination therapy of chemoembolization and hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis compared with chemoembolization alone: a propensity score‐matched analysis. Biomed Research International 2021;2021(1). https://doi.org/10.1155/2021/6670367
23. Ji X., Zhang A., Duan X., & Wang Q.. Stereotactic body radiotherapy versus lenvatinib for hepatocellular carcinoma with portal vein tumor thrombosis: a propensity score analysis. 2023. https://doi.org/10.21203/rs.3.rs-2974472/v1
24. Cai M., Huang W., Huang J., Shi W., Guo Y., Liang L., et al.Transarterial chemoembolization combined with lenvatinib plus PD-1 inhibitor for advanced hepatocellular carcinoma: a retrospective cohort study. Frontiers in Immunology 2022;13. https://doi.org/10.3389/fimmu.2022.848387
25. Ye Z., Li Z., Song M., Yang Z., Zhang W., Zhang J.et al.. Drug-eluting bead transarterial chemoembolization as neoadjuvant therapy pre-liver transplantation for advanced-stage hepatocellular carcinoma. World Journal of Gastrointestinal Oncology 2024;16(6):2476-2486. https://doi.org/10.4251/wjgo.v16.i6.2476
26. Cao Y., Sun T., Guo X., Ouyang T., Kan X., Chen L.et al.. Sorafenib versus apatinib, both combined with transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombosis: a comparative retrospective study. Frontiers in Oncology 2021;11. https://doi.org/10.3389/fonc.2021.673378
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Dr Muhammad Usman Younas
Consultant Interventional, Radiologist, PKLI & RC Lahore
Dr Muhammad Ramzan
Consultant Radiologist, PKLI & RC Lahore
Dr Sadia Abdullah
MRCP, FRCR, Consultant Clinical Oncologist, SKMCH Lahore
Dr Khoala Riaz
Clinical Fellow, Interventional Radiology, PKLI & RC Lahore
Dr Abdullah Saeed
Consultant Interventional Radiologist, Chairman & HOD, Department of Radiology, PKLI & RC Lahore
Dr Asim Ali
Clinical Fellow, Interventional Radiology, PKLI & RC Lahore
