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Reuters Health Information (2012-03-28): Surgery better than chemoembolization for HCC with portal vein thrombus


Surgery better than chemoembolization for HCC with portal vein thrombus

Last Updated: 2012-03-28 12:44:09 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Patients with hepatocellular carcinoma (HCC) complicated by portal vein tumor thrombus survive longer after resection than after transcatheter arterial chemoembolization (TACE), a retrospective study suggests.

Median survival was 20 months for the hepatic resection group and 13 months for the TACE group. Overall survival rates were significantly higher for hepatic resection than for TACE at one year (42.0% vs 37.8%, respectively), three years (14.1% vs 7.3%), and five years (11.1% vs 0.5%), with p values for all comparisons <0.001.

The data from 561 men and 42 women with resectable HCC and PVTT were reported by Dr. Min-Shan Chen from Sun Yat-Sen University, Guangzhou, China, and colleagues online February 22 in Cancer.

The cohort included 201 patients who had resection as their initial treatment and 402 matched controls who were treated first with TACE.

According to the paper, the better survival after resection was seen in patients with types I or II PVTT, but not among patients with type III or IV PVTT.

The survival benefit with resection was also limited to patients with a single tumor, especially those with a single tumor larger than five cm.

In multivariate analysis, however, only the type of PVTT and the treatment allocation to resection or TACE were significantly associated with overall survival outcome.

The rate of portal vein invasion in HCC approaches 40%, the authors note.

"Further clinical studies, preferably in the form of prospective randomized trials with adequate sample sizes and prolonged follow-up, are required," the authors note.

"In the absence of such data," they conclude, "surgery is still the standard of care for resectable HCC with PVTT, whereas TACE remains a local therapy option for patients who do not qualify for surgery."


Cancer 2012.

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