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04.05.2018 | Hepatobiliary Tumors | Ausgabe 7/2018

Annals of Surgical Oncology 7/2018

Postoperative Adjuvant Trans-Arterial Chemoembolization for Patients with Hepatocellular Carcinoma and Portal Vein Tumor Thrombus

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 7/2018
Autoren:
PhD Shuang Liu, PhD Lei Guo, PhD Hui Li, PhD Bo Zhang, MD Jialei Sun, PhD Chenghao Zhou, PhD Jian Zhou, PhD Jia Fan, PhD Qinghai Ye

Abstract

Background

It remains uncertain whether patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) benefit from postoperative adjuvant trans-arterial chemoembolization (PA-TACE).

Methods

We retrospectively identified 540 patients to form the crude cohort and adopted propensity score matching analysis to assemble another cohort of 464 patients with similar baseline characteristics. Univariate and multivariate Cox analyses were performed in exploratory subgroups to identify the independent effect of PA-TACE on overall survival (OS).

Results

In the overall study population, univariate analysis showed PA-TACE was associated with longer OS [odds ratio (OR) = 0.55, p = 0.001], and stratified analyses indicated an interaction between PVTT types and PA-TACE on OS (p = 0.057 for interaction). After matching, all of the characteristics were well balanced between the PA-TACE and control groups (all p > 0.05). Multivariate Cox analysis validated that the protective role of PA-TACE was significant greater with the expansion of PVTT (type I, OR 0.66; type II, OR 0.33; and type III, OR 0.33, respectively, p = 0.011 for interaction). There also was evidence of treatment effect modification by PVTT type in the crude cohort (type I, OR 0.60; type II, OR 0.32; and type III, OR 0.32, respectively, p = 0.011 for interaction).

Conclusions

In patients with HCC and PVTT, PA-TACE was associated with a lower risk of death, particularly, among those with PVTT involving right/left or main portal vein, after excluding patients who were unsuitable for this procedure at 1 month after surgery.

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Zusatzmaterial
Supplementary material 1 (DOCX 347 kb)
10434_2018_6438_MOESM1_ESM.docx
Figure S1. Effect of PA-TACE on overall survival in exploratory subgroups. Odds ratio of PA-TACE on overall survival appeared to be different in various PVTT types subgroups (OR 0.68, 0.39 and 0.36, respectively, crude P for interaction = 0.057). In addition, there was no significantly different treatment effect of PA-TACE in any of the remain sub-groups (all, P > 0.05). Supplementary material 2 (TIFF 454 kb)
10434_2018_6438_MOESM2_ESM.tif
Figure S2. Overall survival curves for patients with different types of PVTT in the PS-matched cohort. In the PS-matched cohort, patients with Type III and Type II PVTT had shorter OS than those with Type I (mean survival time 22, 24 and 34 months, respectively, P = 0.001). Supplementary material 3 (TIFF 1233 kb)
10434_2018_6438_MOESM3_ESM.tif
Figure S3. Overall survival curves for patients in the PA-TACE and control groups stratified by PVTT types in the crude cohort. The overall survival of patients who received PA-TACE were significantly lower than those of patients who did not receive PA-TACE in type I PVTT (mean survival time 43 vs. 33 months, P = 0.015, a), type II PVTT (mean survival time 29 vs. 15 months, P < 0.01, b) and type III PVTT (mean survival time 25 vs. 13 months, P < 0.01, c) subgroups. Supplementary material 4 (TIFF 344 kb)
10434_2018_6438_MOESM4_ESM.tif
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