Transarterial Chemoembolization For Primary Liver Cancer With Portal Vein Tumor Thrombus

Purpose We aimed to compare the survival benefit of transarterial chemoembolization (TACE) with conservative treatment for patients with primary liver cancer (PLC) and portal vein tumor thrombosis (PVTT), furthermore, to reveal which PVTT type benefit from TACE treatment.Methods From December 2008 to December 2009, a prospective controlled study was performed on consecutive patients with PLC and PVTT. Of a total of 148 patients, 115 were treated with TACE (lipiodol and anticancer agents±gelatin sponge embolization), and 33 who refused to accept the procedures were treated with conservative treatment. We performed survival analysis of the two treatment groups according to stratification by a new classification of PVTT which was divided into 4 types. Results Overall survival were signiffcantly better in the TACE group than in the conservative group (9.0 vs 1.4 month, P<0.001). The overall median survival for types I to IV PVTT were 12.0, 7.0, 4.5 and 3.2months (P<0.05). Patients with PVTT types I and II showed significantly better survival than those with PVTT types III and IV. On subgroup analysis of PVTT, the TACE group had significantly better survival than the conservative group for types II, III, and IV PVTT (P<0.01), but whether the survival benefit obtained from TACE was not confirmed for the type I PVTT (P>0.05).Conclusions TACE may provide a significantly better survival benefit than conservative treatment for HCC patients with PVTT .