Boris Gorodetski, Presenter: Nothing to Disclose

Julius Chapiro MD, Abstract Co-Author: Nothing to Disclose

Bareng Nonyane, Abstract Co-Author: Nothing to Disclose

Rafael Duran MD, Abstract Co-Author: Nothing to Disclose

MingDe Lin PhD, Abstract Co-Author: Employee, Koninklijke Philips NV

Jean-Francois H. Geschwind MD, Abstract Co-Author: Consultant, BTG International Ltd Consultant, Bayer AG Consultant, Guerbet SA Consultant, Nordion, Inc Grant, BTG International Ltd Grant, F. Hoffmann-La Roche Ltd Grant, Bayer AG Grant, Koninklijke Philips NV Grant, Nordion, Inc Grant, ContextVision AB Grant, CeloNova BioSciences, Inc Founder, PreScience Labs, LLC CEO, PreScience Labs, LLC

Our study sought to compare the overall survival (OS) in patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT), treated with conventional (c) or drug-eluting beads (DEB) transarterial chemoembolization (TACE). 

This retrospective analysis included a total of 133 HCC patients with PVT that were treated with cTACE (N=95) or DEB-TACE (N=38) without crossover of therapy. The extent of PVT (peripheral [p] vs. main [m] PVT) was diagnosed on contrast-enhanced MR or CT imaging. Prognostic parameters from the Barcelona Clinic Liver Cancer staging system (Child-Pugh [CP] stage, Performance Status [PS], Lesion diameter and multiplicity, PVT localization, lymph nodes, metastases) and other clinically relevant covariates (tumor type and burden, cirrhosis, sex, age) were included into the nearest-neighbor propensity score 2:1 matching, to achieve balance in treatment allocation. We then fitted a Cox proportional hazard regression model for time to death and treatment, adjusting for other covariates as potential confounders.

A total of 102 patients were successfully matched (31 were excluded). A total of 34 patients were treated with DEB-TACE and 68 were treated with cTACE. The distribution of parameters was almost equal between the groups, for DEB-TACE and cTACE, respectively: N= 23 (67.6%) and N= 45 (66.2%) had mPVT, N=22 (64.7%) and N=41 (60.3%) had CP >A, N=28 (82.4%) and N=52 (76.5%) had PS > 0, N= 30 (88.2%) and N=60 (88.2%) had multiple lesions, N=32 (94.1%) and N=66 (97.1%) had a tumor diameter > 3cm. The median OS of the matched cohort (N=102) was 4.5 months (95% CI, 3.1-6.0). As for the treatment groups, median OS was 5.0 months (95% CI, 3.5-6.5) for cTACE and 3.3 months (95% CI, 2.5-4.2) for DEB-TACE (log-rank test, P=0.394).The adjusted hazard ratio from the Cox regression was 1.23 (95% CI, 0.71-2.11, P=0.46). 

Both cTACE and DEB-TACE achieved similar survival outcomes in patients with advanced-stage HCC and PVT. A trend towards better median OS in patients treated with cTACE was observed. 

DEB-TACE did not provide significant survival benefits in the treatment of patients with advance-stage HCC and PVT when compared to cTACE. 

Gorodetski, B, Chapiro, J, Nonyane, B, Duran, R, Lin, M, Geschwind, J, Survival Outcomes in Patients with Advanced-stage HCC and Portal Vein Thrombosis: Comparison between Conventional and Drug-eluting Beads TACE.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007348.html