Dong Hyun Sinn1, Hye Won Lee2, Yong-Han Paik3, Do Young Kim2, Yoon Jun Kim4, Kang Mo Kim5, Si Hyun Bae6, Ji Hoon Kim7, Yeon Seok Seo7, Jae Young Jang8, Byoung Kuk Jang9, Hyung Joon Yim7, Hyung Joon Kim10, Byung Seok Lee11, Bo Hyun Kim12, In Hee Kim13, Eun-Young Cho14, Jung Il Lee2, Kyung-Suk Suh15. 1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea. 2. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. 3. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea. yh.paik@skku.edu. 4. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea. 5. Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea. 6. Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea. 7. Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea. 8. Department of Internal Medicine, Soonchunhyang University, Seoul, South Korea. 9. Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea. 10. Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea. 11. Department of Internal Medicine, Chungnam University College of Medicine, Daejeon, South Korea. 12. Center for Liver Cancer, National Cancer Center, Goyang, South Korea. 13. Department of Internal Medicine, Chonbuk National University, Chonju, South Korea. 14. Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, South Korea. 15. Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Abstract
BACKGROUND AND AIMS: Sorafenib is a proven first-line treatment recommended for hepatocellular carcinoma (HCC) patients with portal vein invasion (PVI). However, multiple treatment modalities are used in clinical practice as a first-line option. This study is a prospective, observational, multicenter, cohort study evaluating patterns of treatment modalities and outcomes for HCC patients with PVI. METHODS: The baseline characteristics, treatment modalities, and outcomes were prospectively collected for 287 newly diagnosed HCC patients with PVI between August 2015 and July 2016 from 16 sites in Korea. RESULTS: During a median 7.8 months of follow-up (range 0.3-24.6 months), mortality was observed in 123 (42.9%) patients. Decision tree analysis classified patients into five subgroups with different outcomes. The patterns of treatment were very heterogeneous, and there was no dominant treatment modality. The most commonly used treatment modality was transarterial chemoembolization (TACE) (20.2%) followed by TACE plus external beam radiation therapy (17.8%) and sorafenib (12.5%). When stratified according to the extent of PVI, sorafenib treatment showed comparable outcomes when the PVI extent was lobal or main/bilateral, yet showed worse outcomes when the PVI extent was limited to the segmental level compared to those who received treatment other than sorafenib. CONCLUSIONS: HCC patients with PVI comprise a heterogeneous population and are treated with various treatment modalities with diverse clinical outcomes in clinical practice. Subclassification of HCC patients with PVI is required to minimize heterogeneity and should be considered for the selection of treatment modalities and future clinical trials.
BACKGROUND AND AIMS: Sorafenib is a proven first-line treatment recommended for hepatocellular carcinoma (HCC) patients with portal vein invasion (PVI). However, multiple treatment modalities are used in clinical practice as a first-line option. This study is a prospective, observational, multicenter, cohort study evaluating patterns of treatment modalities and outcomes for HCCpatients with PVI. METHODS: The baseline characteristics, treatment modalities, and outcomes were prospectively collected for 287 newly diagnosed HCCpatients with PVI between August 2015 and July 2016 from 16 sites in Korea. RESULTS: During a median 7.8 months of follow-up (range 0.3-24.6 months), mortality was observed in 123 (42.9%) patients. Decision tree analysis classified patients into five subgroups with different outcomes. The patterns of treatment were very heterogeneous, and there was no dominant treatment modality. The most commonly used treatment modality was transarterial chemoembolization (TACE) (20.2%) followed by TACE plus external beam radiation therapy (17.8%) and sorafenib (12.5%). When stratified according to the extent of PVI, sorafenib treatment showed comparable outcomes when the PVI extent was lobal or main/bilateral, yet showed worse outcomes when the PVI extent was limited to the segmental level compared to those who received treatment other than sorafenib. CONCLUSIONS:HCCpatients with PVI comprise a heterogeneous population and are treated with various treatment modalities with diverse clinical outcomes in clinical practice. Subclassification of HCCpatients with PVI is required to minimize heterogeneity and should be considered for the selection of treatment modalities and future clinical trials.
Authors: Myoung Ki Sim; Do Young Kim; Jun Yong Park; Ja Kyung Kim; Sung Ai Kim; Sang Hoon Ahn; Chae Yoon Chon; Young Myoung Moon; Jong Yun Won; Do-Yun Lee; Kwang Hyub Han Journal: Korean J Hepatol Date: 2005-09
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