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Patterns and Outcomes in Hepatocellular Carcinoma Patients with Portal Vein Invasion: A Multicenter Prospective Cohort Study

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Abstract

Background and Aims

Sorafenib is a proven first-line treatment recommended for hepatocellular carcinoma (HCC) patients with portal vein invasion (PVI). However, multiple treatment modalities are used in clinical practice as a first-line option. This study is a prospective, observational, multicenter, cohort study evaluating patterns of treatment modalities and outcomes for HCC patients with PVI.

Methods

The baseline characteristics, treatment modalities, and outcomes were prospectively collected for 287 newly diagnosed HCC patients with PVI between August 2015 and July 2016 from 16 sites in Korea.

Results

During a median 7.8 months of follow-up (range 0.3–24.6 months), mortality was observed in 123 (42.9%) patients. Decision tree analysis classified patients into five subgroups with different outcomes. The patterns of treatment were very heterogeneous, and there was no dominant treatment modality. The most commonly used treatment modality was transarterial chemoembolization (TACE) (20.2%) followed by TACE plus external beam radiation therapy (17.8%) and sorafenib (12.5%). When stratified according to the extent of PVI, sorafenib treatment showed comparable outcomes when the PVI extent was lobal or main/bilateral, yet showed worse outcomes when the PVI extent was limited to the segmental level compared to those who received treatment other than sorafenib.

Conclusions

HCC patients with PVI comprise a heterogeneous population and are treated with various treatment modalities with diverse clinical outcomes in clinical practice. Subclassification of HCC patients with PVI is required to minimize heterogeneity and should be considered for the selection of treatment modalities and future clinical trials.

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Abbreviations

PVI:

Portal vein invasion

HCC:

Hepatocellular carcinoma

BCLC:

Barcelona Clinic Liver Cancer

TACE:

Transarterial chemoembolization

HAIC:

Hepatic arterial infusion chemotherapy

AFP:

Alpha-fetoprotein

EBRT:

External beam radiation therapy

AUROC:

Area under the receiver operating characteristic

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Funding

This study was supported in part by the Korean Liver Cancer Association 2016 study grant.

Author information

Author notes

  1. Dong Hyun Sinn and Hye Won Lee contributed equally to this study.

Authors and Affiliations

  1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea

    Dong Hyun Sinn & Yong-Han Paik

  2. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea

    Hye Won Lee, Do Young Kim & Jung Il Lee

  3. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea

    Yoon Jun Kim

  4. Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea

    Kang Mo Kim

  5. Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea

    Si Hyun Bae

  6. Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea

    Ji Hoon Kim, Yeon Seok Seo & Hyung Joon Yim

  7. Department of Internal Medicine, Soonchunhyang University, Seoul, South Korea

    Jae Young Jang

  8. Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea

    Byoung Kuk Jang

  9. Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea

    Hyung Joon Kim

  10. Department of Internal Medicine, Chungnam University College of Medicine, Daejeon, South Korea

    Byung Seok Lee

  11. Center for Liver Cancer, National Cancer Center, Goyang, South Korea

    Bo Hyun Kim

  12. Department of Internal Medicine, Chonbuk National University, Chonju, South Korea

    In Hee Kim

  13. Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, South Korea

    Eun-Young Cho

  14. Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea

    Kyung-Suk Suh

Authors
  1. Dong Hyun Sinn
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  2. Hye Won Lee
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  15. Bo Hyun Kim
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  18. Jung Il Lee
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  19. Kyung-Suk Suh
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Correspondence to Yong-Han Paik.

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Sinn, D.H., Lee, H.W., Paik, YH. et al. Patterns and Outcomes in Hepatocellular Carcinoma Patients with Portal Vein Invasion: A Multicenter Prospective Cohort Study. Dig Dis Sci 66, 315–324 (2021). https://doi.org/10.1007/s10620-020-06134-4

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  • DOI: https://doi.org/10.1007/s10620-020-06134-4

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