| Background & AimsIn this study,we evaluated the survival outcome of unresectable hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT)who received transarterial chemoembolization(TACE)combined with radiotherapy(RT),aiming to provide evidence to the treatment guideline of HCC with PVTT.MethodsThe first part of this study retrospectively analyzed 847 patients suffering HCC with PVTT and divided them into two groups: patients in TACE+RT Group(n = 112)received TACE combined with RT and the other patients in TACE Group(n = 735)received TACE alone.Compared differences of response rate,survival time and adverse events between the two groups and concluded risk factors that affect prognosis.Besides,subgroup analysis was performed according to different types of PVTT,and propensity score matching analysis(PSM)was used in an attempt to reduce bias in patient selection.The second part of this study retrospectively analyzed 112 HCC patients with PVTT receiving the treatment combination of RT and TACE and divided them into two groups: patients in TACE-RT Group(n = 76)received TACE followed by RT and the other patients in RT-TACE Group(n = 36)received RT followed by TACE.Compared differences of response rate,survival time and adverse events between the two groups and concluded risk factors that affect prognosis.Besides,subgroup analysis was performed according to different types of PVTT,and propensity score matching analysis(PSM)was used in an attempt to reduce bias in patient selection.ResultsIn the first part of this study,for parenchyma tumor and PVTT,the response rates of the patients in the TACE+RT group(66.1% and 72.3%)were significantly higher than those in the TACE group(50.2% and 34.7%)(P = 0.002 and < 0.001),especially in patients with PVTT involving right/left portal vein and main portal vein trunk.Of the whole study population,TACE combined with RT showed significant survival benefits compared with TACE alone,the survival rate of 1-,2-,3-year of the two groups were 44.6% and 21.6%,21.0% and 7.7%,14.1% and 2.0%,respectively(P < 0.001).In the subgroup analysis,patients with PVTT involving right/left portal vein and main portal vein trunk could gain more benefit receiving TACE+RT than TACE.For patients with PVTT involving right/left portal vein,the survival rate of 1-,2-,3-year of the two groups were 48.9% and 22.2%,22.9% and 8.3%,11.3% and 3.1%,respectively(P < 0.001).For patients with PVTT involving portal vein trunk,the survival rate of 1-,2-,3-year of the two groups were 37.0% and 19.1%,16.2% and 5.6%,13.5% and 0.7%,respectively(P < 0.001).After one-to-one PSM,108 pairs of matched patients were selected for further analysis.In the propensity model,the survival rate of 1-,2-,3-year of the two groups were 44.4% and 19.4%,20.8% and 7.6%,13.7% and 0,respectively(P < 0.001)for all patients,48.9% and 19.1%,22.9% and 8.9%,11.3% and 0,respectively(P = 0.002)for patients with PVTT involving right/left portal vein and 35.8% and 11.3%,16.5% and 3.8%,13.8% and 0,respectively(P < 0.001)for patients with PVTT involving main portal vein trunk.The maximum lesion diameter and main trunk PVTT were the independent prognostic factors for survival at uni-and multivariate analysis.The difference of adverse events between the two groups was not significant.In the second part of this study,for parenchyma tumor and PVTT,the difference of response rates of the patients between two groups(TACE-RT vs RT-TACE)are not significant(59.2% vs 72.2%,P = 0.182 for tumor response and 61.8% vs 77.8%,P = 0.094 for PVTT response).However,in the subgroup analysis,patients with PVTT involving main portal vein trunk could gain higher response rates receiving RT-TACE than TACE-RT,for parenchyma tumor(81.0% vs 50.0%,P = 0.021)and PVTT(85.7% vs 50.0%,P = 0.007).After one-to-two PSM,75 patients were selected for analysis.There is no significant difference in overall survival between the two groups for all patients before(P = 0.206)or after PSM(P = 0.072).However,in the subgroup analysis,patients with PVTT involving main portal vein trunk could have longer survival time receiving RT-TACE than TACE-RT before(P = 0.031)and after PSM(P = 0.020).The maximum lesion diameter and main trunk PVTT were the independent prognostic factors for survival at uni-and multivariate analysis.For patients with PVTT involving main portal vein trunk,TACE-RT could lead a higher exacerbation rate of liver function than RT-TACE(47.2% vs 19.0%,P = 0.033).ConclusionsFor patients with unresctable HCC with PVTT,TACE combined with RT could provide a better tumor and PVTT response rate and a longer survival time,especially for patients with PVTT involving right/left portal vein and main portal vein trunk.The combination treatment added no more adverse events to the patients.The maximum lesion diameter and main trunk PVTT were the independent prognostic factors for survival of the HCC patients with PVTT.For patients with unresctable HCC with PVTT receiving the combination treatment,the tumor and PVTT response rate,the survival time and adverse events are similar between the two consequences of treatment for all patients.However,for patients with PVTT involving main portal vein trunk,RT followed by TACE could provide a higher tumor and PVTT response rate,a longer survival time and a lower exacerbation rate of liver function than TACE followed by RT. |
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