Transcatheter Arterial Chemoembolization for Advanced Hepatocellular Carcinoma with Portal Vein Invasion: Safety, Efficacy, and Prognostic Factors

Purpose: To evaluate the safety and efficacy of transarterial chemoembolization and to identify the prognostic factors associated with survival in patients with hepatocellular carcinoma (HCC) and portal vein (PV) invasion. Materials and Methods: From January 2006 to March 2012, 50 patients with HCC, invading into the PV (Barcelona Clinic Liver Cancer stage C) were treated With transarterial chemoembolization. The parenchymal tumor and PV tumor were confirmed by multidetector computed tomography (CT) and angiography. There were 14 patients with right PV tumor, 12 patients With left PV tumor, and 24 patients with main PV tumor. The response was evaluated by multidetector CT using Response Evaluation Criteria in Solid Tumors. Patient with residual tumors received repeated transarterial chemoembolization. every 64 weeks unless the Patients achieved complete remission or developed contraindications. Results: The median survival period of the entire group was 6.2 months (range, 1.7-50.9 mo), and the overall response rate was 42% (21 of 50 patients). The 6-month, 12-month, 24-month, and 36-month survival rates were 54%, 22%, 104, and 8%. There were no instances of 30 day mortality or acute liver failure related to transarterial. Chemoembolization. The median: survival of the 21 responders was 103 months, and the Median survival of the 29 nonresponders was 53 months (P < .001). In both. univariate and multivariate analyses, Only the response to transarterial chemoembolization (hazard ratio = 0.25, P < .001) and the absence of ascites (hazard ratio = 0.24, P = .01) were significant prognostic factors. Conclusions: Transarterial chemoembolization is a safe and effective treatment for HCC with major PV invasion. The response to transarterial chemoembolization and the asoites status were the:the most significant predictive factors for prolonged survival.