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

Dong Hyun Sinn, Hye Won Lee, Yong Han Paik, Do Young Kim, Yoon Jun Kim, Kang Mo Kim, Si Hyun Bae, Ji Hoon Kim, Yeon Seok Seo, Jae Young Jang, Byoung Kuk Jang, Hyung Joon Yim, Hyung Joon Kim, Byung Seok Lee, Bo Hyun Kim, In Hee Kim, Eun Young Cho, Jung Il Lee, Kyung Suk Suh

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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.

Original languageEnglish
JournalDigestive Diseases and Sciences
DOIs
Publication statusAccepted/In press - 2020 Jan 1

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Keywords

  • Cohort
  • Hepatocellular carcinoma
  • Portal vein invasion

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Sinn, D. H., Lee, H. W., Paik, Y. H., Kim, D. Y., Kim, Y. J., Kim, K. M., Bae, S. H., Kim, J. H., Seo, Y. S., Jang, J. Y., Jang, B. K., Yim, H. J., Kim, H. J., Lee, B. S., Kim, B. H., Kim, I. H., Cho, E. Y., Lee, J. I., & Suh, K. S. (Accepted/In press). Patterns and Outcomes in Hepatocellular Carcinoma Patients with Portal Vein Invasion: A Multicenter Prospective Cohort Study. Digestive Diseases and Sciences. https://doi.org/10.1007/s10620-020-06134-4