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Annals of Surgical Oncology

, Volume 25, Issue 11, pp 3308–3315 | Cite as

Downstaging with Localized Concurrent Chemoradiotherapy Can Identify Optimal Surgical Candidates in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

  • Jae Uk Chong
  • Gi Hong Choi
  • Dai Hoon Han
  • Kyung Sik Kim
  • Jinsil Seong
  • Kwang-Hyub Han
  • Jin Sub Choi
Hepatobiliary Tumors

Abstract

Background

Locally advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) has a poor oncological outcome. This study evaluated the oncological outcomes and prognostic factors of surgical resection after downstaging with localized concurrent chemoradiotherapy (CCRT) followed by hepatic arterial infusion chemotherapy (HAIC).

Methods

From 2005 to 2014, 354 patients with locally advanced HCC underwent CCRT followed by HAIC. Among these patients, 149 patients with PVTT were analyzed. Exclusion criteria included a total bilirubin ≥ 2 mg/dL, platelet count < 100,000/μL, and indocyanine green retention test (ICG R15) > 20%. During the same study period, 18 patients with PVTT underwent surgical resection as the first treatment. Clinicopathological characteristics and oncological outcomes between groups were compared.

Results

Among 98 patients in the CCRT group, 26 patients (26.5%) underwent subsequent curative resection. The median follow-up period was 13 months (range 1–131 months). Disease-specific survival differed significantly between the resection after localized CCRT group and the resection-first group {median 62 months (95% confidence interval [CI] 22.99–101.01) versus 15 months (95% CI 10.84–19.16), respectively; P = 0.006}. Multivariate analyses showed that achievement of radiologic response was an independently good prognostic factor for both disease-specific survival (P = 0.039) and disease-free survival (P = 0.001)

Conclusions

Localized CCRT could be an effective tool for identifying optimal candidates for surgical treatment with favorable tumor biology. Furthermore, with a 26.5% resection rate and 100% response in PVTT for resection after CCRT, our localized CCRT protocol may be ideal for PVTT.

Notes

Conflicts of interest

Jae Uk Chong, Gi Hong Choi, Dai Hoon Han, Kyung Sik Kim, Jinsil Seong, Kwang-Hyub Han, and Jin Sub Choi have no conflicts of interest to declare.

Supplementary material

10434_2018_6653_MOESM1_ESM.docx (281 kb)
Supplementary material 1 (DOCX 113 kb)

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Jae Uk Chong
    • 1
  • Gi Hong Choi
    • 1
  • Dai Hoon Han
    • 1
  • Kyung Sik Kim
    • 1
  • Jinsil Seong
    • 2
  • Kwang-Hyub Han
    • 3
  • Jin Sub Choi
    • 1
  1. 1.Division of Hepatobiliary and Pancreatic Surgery, Department of SurgeryYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Radiation OncologyYonsei University College of MedicineSeoulRepublic of Korea
  3. 3.Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea

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