Open AccessComparison of three‐dimensional conformal radiotherapy and hepatic resection in hepatocellular carcinoma with portal vein tumor thrombus
Author(s) -
Su Fang,
Chen KaiHua,
Liang ZhongGuo,
Wu ChunHua,
Li Ling,
Qu Song,
Chen Long,
Zhu XiaoDong,
Zhong JianHong,
Li LeQun,
Xiang BangDe
Publication year - 2018
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.1708
Subject(s) - hepatocellular carcinoma , medicine , portal vein , proportional hazards model , gastroenterology , thrombus , subgroup analysis , radiation therapy , multivariate analysis , meta analysis
Objective This study aimed to evaluate the safety and efficacy of three‐dimensional conformal radiotherapy (3D‐CRT) and hepatic resection for patients with hepatocellular carcinoma (HCC) involving portal vein tumor thrombus (PVTT). Methods We retrospectively analyzed 323 HCC patients involving PVTT. Among them, 134 patients underwent 3D‐CRT, while 189 controls treated with hepatic resection (HR). Survival rate and prognostic analysis were performed using Kaplan‐Meier method and Cox regression analyses. Results The 1‐, 2‐, and 3‐year overall survival (OS) of RT group and HR group was 54% vs 62%, 33% vs 47%, and 18% vs 43%, respectively ( P = 0.003). In the subgroup of PVTT type analysis, the 1‐, 2‐, and 3‐year OS in RT group was 65%, 39%, and 19%, respectively, while that in HR group was 83%, 53%, and 42%, respectively, in type I PVTT ( P < 0.001). The 1‐, 2‐, and 3‐year OS in RT group was 52%, 35%, and 11%, while that in HR group was 55%, 42%, and 25%, respectively, in type II PVTT ( P = 0.612). In type III PVTT, the 1‐, 2‐, and 3‐year OS in RT group was 16%, 3%, and 0%, respectively, while that in HR group was 11%, 0%, and 0%, respectively ( P = 0.041). Multivariate analysis revealed that tumor size ≥10 cm, Child‐Pugh class B, and type III PVTT are independent predictors of poor prognosis in HCC with PVTT. Conclusion 3D‐CRT appears to be an effective treatment for patients with HCC involving type II/III PVTT.