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Prognosis Nomogram for Hepatocellular Carcinoma Patients with Portal Vein Invasion Undergoing Transarterial Chemoembolization Plus Sorafenib Treatment: A Retrospective Multicentre Study

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Objectives

To explore the outcomes of combined transarterial chemoembolization (TACE) with sorafenib in hepatocellular carcinoma (HCC) patients with portal vein tumour thrombus (PVTT) and to establish a prognostic prediction nomogram to differentiate target patients and stratify risk.

Materials and Methods

This multicentre, retrospective study consisted of 185 consecutive treatment-naïve patients with HCC and PVTT treated with TACE plus sorafenib from three institutions between January 1st, 2012 and December 31st, 2017. The primary outcome measurement of the study was overall survival (OS). The type of PVTT was classified by the Liver Cancer Study Group of Japan. The prognostic nomogram was established based on the predictors and was performed with interval validation.

Results

The median OS of the Vp1-3 and Vp4 groups was 12.4 months (11.7–18.9) and 8.5 months (7.6–11.2) (P = 0.00098), respectively, and there was a significant difference in the median OS between the Vp1-2 and Vp3 subgroups (16.4 months (12.2–27.9) vs. 10.9 months (8.4–18.1), P = 0.041). The multivariate Cox regression analysis suggested that tumour size, albumin-bilirubin grade, and PVTT type were independent prognostic factors. The C-index value of the nomogram based on these predictors in the entire cohort was 0.731 (0.628–0.833).

Conclusions

After the combined therapy of TACE and sorafenib, advanced HCC patients with segmental or subsegmental PVTT showed better survival than those with main PVTT. The nomogram can be applied to identify advanced HCC patients with PVTT who may benefit most from the combination treatment and be helpful for making decision in clinical practice.

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Abbreviations

HCC:

Hepatocellular carcinoma

BCLC:

Barcelona clinic liver cancer

TACE:

Transarterial chemoembolization

cTACE:

Conventional transarterial chemoembolization

OS:

Overall survival

PFS:

Progression-free survival

PVTT:

Portal vein tumour thrombus

IRBs:

Institutional review boards

EASL:

European association for the study of the liver

AASLD:

American association for the study of liver diseases

CT:

Computed tomography

CECT:

Contrast-enhanced computed tomography

ECOG:

Eastern cooperative oncology group

VEGF:

Vascular endothelial growth factor

PDGFR:

Platelet-derived growth factor receptor

LCSGJ:

Liver cancer study group of Japan

MRI:

Magnetic resonance imaging

ALBI:

Albumin-bilirubin

CTP:

Child-turcotte-pugh

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

TTP:

Time to progression

TTR:

Tumour response rate

CTCAE:

Common terminology criteria of adverse events

C-index:

Concordance index

mRECIST:

Modified response evaluation criteria in solid tumors

AEs:

Adverse events

CI:

Confidence interval

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Acknowledgements

None

Funding

This study was supported by the National Natural Science Foundation of China (81901847) (81771945) (81971713), the Jiangsu Medical Innovation Team (CXTDB2017006), the Natural Science Foundation of Jiangsu Province (BK20190177), the Natural Science Foundation of Zhejiang Province (LZ18H180001), the Suzhou Science and Technology Youth Plan (KJXW2018003) and “Six One Projects” for High-level Health Personnel in Jiangsu Province (LGY2018077). Funding source had no involvement in the financial support for the conduct of the research and preparation of the article.

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Author notes

  1. Lei Zhang, Jun-Hui Sun, Zhong-Heng Hou and Bin-Yan Zhong have contributed equally as joint first authors.

  2. Zhi-Ping Yan and Cai-Fang Ni have contributed equally as joint corresponding authors.

Authors and Affiliations

  1. Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, No. 188, Shizi Street, Suzhou, 215006, China

    Lei Zhang, Zhong-Heng Hou, Bin-Yan Zhong, Wan-Sheng Wang, Peng Huang, Shen Zhang, Zhi Li, Xiao-Li Zhu & Cai-Fang Ni

  2. Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Jun-Hui Sun & Guan-Hui Zhou

  3. Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    Min-Jie Yang & Zhi-Ping Yan

  4. Shanghai Institution of Medical Imaging, Shanghai, China

    Min-Jie Yang & Zhi-Ping Yan

  5. National Clinical Research Center for Interventional Medicine, Shanghai, China

    Min-Jie Yang & Zhi-Ping Yan

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Contributions

All authors contributed to review and critical revision of the manuscript and approved the final version of the manuscript. CFN, ZPY, LZ, JHS, ZHH, and BYZ contributed to the study concept and design, LZ, ZHH, BYZ, PH, SZ, MJY, GHZ, WSW, ZL, and XLZ contributed to acquisition of data, LZ, ZHH, and BYZ contributed to analysis and interpretation of data, LZ, ZHH, and BYZ contributed to statistical analysis, LZ, JHS, ZHH, and BYZ contributed to drafting of the manuscript. The corresponding author had full access to all of the data and took full responsibility for the veracity of the data and the statistical analyses.

Corresponding authors

Correspondence to Zhi-Ping Yan or Cai-Fang Ni.

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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.

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Zhang, L., Sun, JH., Hou, ZH. et al. Prognosis Nomogram for Hepatocellular Carcinoma Patients with Portal Vein Invasion Undergoing Transarterial Chemoembolization Plus Sorafenib Treatment: A Retrospective Multicentre Study. Cardiovasc Intervent Radiol 44, 63–72 (2021). https://doi.org/10.1007/s00270-020-02579-2

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