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Comparison Between Portal Vein Perfusion Chemotherapy and Neoadjuvant Hepatic Arterial Infusion Chemotherapy for Resectable Intermediate to Advanced Stage Hepatocellular Carcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients with intermediate to advanced stage hepatocellular carcinoma (HCC; Barcelona Clinic Liver Cancer [BCLC] stage B/C) have few choices of curable treatments and thus suffer from dismal outcomes. Although surgical resection could prolong survival in certain selected patients with BCLC stage B/C HCC, the frequent postoperative recurrence and poor survival of these patients need to be improved by combining other therapies perioperatively.

Objective

This study was conducted to investigate the survival associations of adjuvant portal vein perfusion chemotherapy (PVC) and neoadjuvant hepatic arterial infusion chemotherapy (HAIC) in patients with resectable BCLC stage B/C HCC.

Methods

A retrospective study was conducted in consecutive patients who underwent R0 resection for intermediate to advanced stage HCC, combined with either PVC or HAIC perioperatively between January 2017 and December 2018. Patients treated with PVC or HAIC were analyzed according to intention-to-treat (ITT) and per protocol (PP) principles, respectively. The chemotherapy regimen of adjuvant PVC and neoadjuvant HAIC included 5-fluorouracil/leucovorin/oxaliplatin. Survival analysis and Cox regression for overall survival (OS) and event-free survival (EFS) were used to compare the outcomes.

Results

Among all 64 patients enrolled in this study, 28 received perioperative PVC and 36 received HAIC for ITT analysis. Age (median 44.00 vs. 46.50 years; p = 0.364), sex (male: 25/28 vs. 35/36; p = 0.435), and tumor size (median 9.55 vs. 8.10 cm; p = 0.178) were comparable between the two groups. In the ITT analysis, the median OS was significantly longer in patients in the HAIC group compared with the PVC group (median OS not reached vs. 19.47 months; p = 0.004); in the PP analysis, patients who received neoadjuvant HAIC followed by hepatectomy presented with much better EFS than patients in the PVC group (modified EFS 16.90 vs. 3.17 months; p = 0.022); and in the multivariate analysis, neoadjuvant HAIC presented as a significant predictor for enhanced EFS (hazard ratio [HR] 0.296; p = 0.007) and OS (HR 0.095; p = 0.007) for BCLC stage B/C HCC patients who received hepatectomy.

Conclusions

Compared with adjuvant PVC, neoadjuvant HAIC treatment was associated with better survival and fewer recurrences in HCC patients who received R0 resection at the intermediate to advanced stage. These results need to be further validated prospectively.

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Data Availability

The data that support the findings of this study are openly available in Research Data Deposit at https://www.researchdata.org.cn/default.aspx, after publication.

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Acknowledgments

The authors acknowledge and express their deepest gratitude to the participants of this study. This work was funded by the National Key R&D Program of China (2020YFE0202200) and National Natural Science Foundation of China (81772589). The study protocol was approved by the Institutional Ethics Committee of the SYSUCC (B2021-132-01) and was conducted according to the ethics guidelines of 1975 Declaration of Helsinki.

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Author notes

  1. Yangxun Pan and Jie Mei contributed equally to this work.

Authors and Affiliations

  1. Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China

    Yangxun Pan MD, Jie Mei MD, Jinbin Chen MD, PhD, Deyao Zhang MD, Juncheng Wang MD, PhD, Xiaohui Wang MD, PhD, Minjiang Yi MD, Zhongguo Zhou MD, PhD, Yaojun Zhang MD, PhD, Minshan Chen MD, PhD, Rongping Guo MD & Li Xu MD, PhD

  2. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China

    Yangxun Pan MD, Jie Mei MD, Jinbin Chen MD, PhD, Deyao Zhang MD, Juncheng Wang MD, PhD, Xiaohui Wang MD, PhD, Minjiang Yi MD, Zhongguo Zhou MD, PhD, Yaojun Zhang MD, PhD, Minshan Chen MD, PhD, Rongping Guo MD & Li Xu MD, PhD

  3. Department of Oncology-Pathology, Karolinska Institutet, Science for Life Laboratory, Stockholm, Sweden

    Yangxun Pan MD

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Correspondence to Li Xu MD, PhD.

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Yangxun Pan, Jie Mei, Jinbin Chen, Deyao Zhang, Juncheng Wang, Xiaohui Wang, Minjiang Yi, Zhongguo Zhou, Yaojun Zhang, Minshan Chen, Rongping Guo, and Li Xu have no conflicts of interest to declare.

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Pan, Y., Mei, J., Chen, J. et al. Comparison Between Portal Vein Perfusion Chemotherapy and Neoadjuvant Hepatic Arterial Infusion Chemotherapy for Resectable Intermediate to Advanced Stage Hepatocellular Carcinoma. Ann Surg Oncol 29, 2016–2029 (2022). https://doi.org/10.1245/s10434-021-10903-4

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