Hepatic Arterial Infusion Chemotherapy Using Oxaliplatin Plus 5-Fluorouracil Versus Transarterial Chemoembolization/Embolization for the Treatment of Advanced Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombosis

Abstract

Purpose

To compare the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) to transarterial chemoembolization/embolization (TACE/TAE) for the treatment of advanced hepatocellular carcinoma (HCC) with major portal vein tumor thrombosis (PVTT).

Materials and Methods

Forty-six patients with advanced HCC with major PVTT who underwent HAIC or TACE/TAE between April 2013 and April 2017 were included. In the HAIC group (n = 22), oxaliplatin (35–40 mg/m2 for 2 h) and 5-fluorouracil (600–800 mg/m2 for 22 h) on days 1–3 every 4 weeks were administered for a maximum of six serial courses. In the TACE/TAE group (n = 24), an emulsion of epirubicin (40–60 mg) and lipiodol was administered followed by particles (cTACE), or particles alone embolization (TAE). Overall survival (OS), tumor response according to mRECIST, progression-free survival (PFS), and adverse events were investigated.

Results

Median OS was 20.8 months in the HAIC group versus 4.0 months in the TACE/TAE group (P < 0.001; hazard ratio [HR], 0.17). The HAIC group showed higher tumor response rates than the TACE/TAE group (59.1% [13/22] vs. 22.7% [5/22]; P = 0.014) and a longer median PFS (9.6 vs. 1.5 months; P < 0.001; HR, 0.09). The Child–Pugh class (P = 0.007) and treatment method (P = 0.002) were independent risk factors of survival. The most frequent grade 3 or worse treatment-related adverse events were liver dysfunction (2 [9.1%] vs. 5 [20.8%]), hematological abnormalities (1 [4.5%] vs. 2 [8.3%]), and fever (1 [4.5%] vs. 4 [16.7%]). One treatment-related death due to acute liver failure occurred 3 days after TACE treatment.

Conclusion

HAIC may significantly improve OS and provide better tumor control with mild side effects and preserved liver function in patients with advanced HCC with major PVTT compared to TACE/TAE treatment.

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Abbreviations

HAIC:

Hepatic arterial infusion chemotherapy

HCC:

Hepatocellular carcinoma

HR:

Hazard ratio

OS:

Overall survival

PFS:

Progression-free survival

PVTT:

Portal vein tumor thrombosis

TACE:

Transarterial chemoembolization

TAE:

Transarterial embolization

TARE:

Transarterial radioembolization

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Acknowledgements

This project was supported by National Science Foundation of China (No. 81471759). We would like to thank Accdon for its linguistic assistance during the preparation of this manuscript. We thank LetPub (www.letpub.com) for its linguistic assistance during the preparation of this manuscript.

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Correspondence to Xiaodong Wang.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent is not required.

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Jungang Hu and Quan Bao are co-first author.

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Hu, J., Bao, Q., Cao, G. et al. Hepatic Arterial Infusion Chemotherapy Using Oxaliplatin Plus 5-Fluorouracil Versus Transarterial Chemoembolization/Embolization for the Treatment of Advanced Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombosis. Cardiovasc Intervent Radiol 43, 996–1005 (2020). https://doi.org/10.1007/s00270-019-02406-3

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Keywords

  • Hepatic arterial infusion chemotherapy
  • Hepatocellular carcinoma
  • Portal vein tumor thrombosis
  • Transarterial chemoembolization