Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Dig Dis Sci. 2021 Jan;66(1):315-324. doi: 10.1007/s10620-020-06134-4. Epub 2020 Feb 13.
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.
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.
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.
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.
索拉非尼是一种已被证实的一线治疗药物，推荐用于合并门静脉侵犯（PVI）的肝细胞癌（HCC）患者。然而，在临床实践中，有多种治疗方式被用作一线选择。本研究是一项前瞻性、观察性、多中心队列研究，旨在评估合并 PVI 的 HCC 患者的治疗模式和结局。
2015 年 8 月至 2016 年 7 月期间，从韩国 16 个地点前瞻性收集了 287 例新诊断为合并 PVI 的 HCC 患者的基线特征、治疗方式和结局。
在中位 7.8 个月的随访期间（范围 0.3-24.6 个月），有 123 例（42.9%）患者死亡。决策树分析将患者分为五个具有不同结局的亚组。治疗模式非常多样化，没有主导的治疗方式。最常用的治疗方式是经动脉化疗栓塞术（TACE）（20.2%），其次是 TACE 加外照射放疗（17.8%）和索拉非尼（12.5%）。根据 PVI 的程度分层，当 PVI 程度为全肝或主/双侧时，索拉非尼治疗的结果与接受索拉非尼以外治疗的患者相当，但当 PVI 程度局限于节段性水平时，索拉非尼治疗的结果比接受索拉非尼以外治疗的患者更差。
合并 PVI 的 HCC 患者构成一个异质性人群，在临床实践中采用各种治疗方式，具有不同的临床结局。需要对合并 PVI 的 HCC 患者进行亚分类，以最大限度地减少异质性，并应考虑用于治疗方式的选择和未来的临床试验。
