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, KwangHyub Han, Jin Sub Choi

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)3308-3315
Number of pages8
JournalAnnals of Surgical Oncology
Volume25
Issue number11
DOIs
Publication statusPublished - 2018 Oct 1

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Chemoradiotherapy
Portal Vein
Hepatocellular Carcinoma
Thrombosis
Neoplasms
Confidence Intervals
Drug Therapy
Survival
Liver
Platelet Count
Bilirubin
Disease-Free Survival
Multivariate Analysis
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

@article{a62915041f4b4e7baf3f97b05fbe0077,
title = "Downstaging with Localized Concurrent Chemoradiotherapy Can Identify Optimal Surgical Candidates in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus",
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.",
author = "Chong, {Jae Uk} and Choi, {Gi Hong} and Han, {Dai Hoon} and Kim, {Kyung Sik} and Jinsil Seong and KwangHyub Han and Choi, {Jin Sub}",
year = "2018",
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pages = "3308--3315",
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Downstaging with Localized Concurrent Chemoradiotherapy Can Identify Optimal Surgical Candidates in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus. / Chong, Jae Uk; Choi, Gi Hong; Han, Dai Hoon; Kim, Kyung Sik; Seong, Jinsil; Han, KwangHyub; Choi, Jin Sub.

In: Annals of Surgical Oncology, Vol. 25, No. 11, 01.10.2018, p. 3308-3315.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Downstaging with Localized Concurrent Chemoradiotherapy Can Identify Optimal Surgical Candidates in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

AU - Chong, Jae Uk

AU - Choi, Gi Hong

AU - Han, Dai Hoon

AU - Kim, Kyung Sik

AU - Seong, Jinsil

AU - Han, KwangHyub

AU - Choi, Jin Sub

PY - 2018/10/1

Y1 - 2018/10/1

N2 - 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.

AB - 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.

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U2 - 10.1245/s10434-018-6653-9

DO - 10.1245/s10434-018-6653-9

M3 - Article

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VL - 25

SP - 3308

EP - 3315

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

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