Liver resection versus intensity-modulated radiation therapy for treatment of hepatocellular carcinoma with hepatic vein tumor thrombus: a propensity score matching analysis

Zhen-Hua Chen; Xiu-Ping Zhang; Shuang Feng; Jing-Kai Feng; Zong-Tao Chai; Wei-Xing Guo; Jie Shi; Wan Yee Lau; Yan Meng; Shu-Qun Cheng

doi:10.21037/hbsn.2020.03.20

Liver resection versus intensity-modulated radiation therapy for treatment of hepatocellular carcinoma with hepatic vein tumor thrombus: a propensity score matching analysis

Hepatobiliary Surg Nutr. 2021 Oct;10(5):646-660. doi: 10.21037/hbsn.2020.03.20.

Authors

Zhen-Hua Chen¹, Xiu-Ping Zhang^{1

2}, Shuang Feng³, Jing-Kai Feng¹, Zong-Tao Chai¹, Wei-Xing Guo¹, Jie Shi¹, Wan Yee Lau^{1

4}, Yan Meng³, Shu-Qun Cheng¹

Affiliations

¹ Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
² Department of Hepatobiliary and Pancreatic Surgical Oncology, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
³ Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
⁴ Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.

Abstract

Background: The presence of hepatic vein tumor thrombus (HVTT) is a major determinant of survival outcomes in hepatocellular carcinoma (HCC) patients. This study compared survival outcomes between liver resection (LR) and intensity-modulated radiation therapy (IMRT) in HCC patients with HVTT.

Methods: Data from patients who underwent LR or IMRT for HCC with HVTT at the Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed. Their survival outcomes were compared before and after propensity score matching (PSM).

Results: Three hundred and seven HCC patients with HVTT who underwent either LR (n=140) or IMRT (n=167) were enrolled. PSM matched 82 pairs of patients. The overall survival (OS) and recurrence-free survival (RFS) rates were significantly higher for patients in the LR group than those in the IMRT group. On subgroup analysis, significantly better survival outcomes were obtained after LR than IMRT in patients with peripheral type of HVTT (pHVTT) and major type of HVTT (mHVTT). However, similar survival outcomes were obtained after LR and IMRT when the HVTT had developed into inferior vena cava tumor thrombus (IVCTT).

Conclusions: LR resulted in significantly better survival outcomes in HCC patients with HVTT when compared to IMRT. Once the HVTT had developed IVCTT, LR and IMRT resulted in similarly bad survival outcomes.

Keywords: Hepatocellular carcinoma (HCC); hepatic vein tumor thrombus (HVTT); liver resection (LR); radiotherapy.