Overall response of both intrahepatic tumor and portal vein tumor thrombosis is a good prognostic factor for hepatocellular carcinoma patients receiving concurrent chemoradiotherapy

Abstract

This study investigated the prognostic significance of portal vein tumor thrombosis (PVTT) response in hepatocellular carcinoma (HCC) patients treated with localized concurrent chemoradiotherapy (CCRT). We retrospectively analyzed 100 patients treated with CCRT for UICC Stage T2-4N0M0 HCC with PVTT between 2002 and 2011. The radiotherapy (RT) volume included both primary tumor and PVTT, and the median radiation dose was 45 Gy. Treatment response was evaluated for up to 6 months after RT. With respect to PVTT response to treatment, complete response (CR) and partial response (PR) were achieved in 14% and 48% of patients, respectively, yielding an objective response (OR) rate of 62%. PVTT size (≤3cm diameter) was associated with a higher rate of a CR (P = 0.001). The median overall survival (OS) was 11.6 months. Independent prognostic factors for OS were OR of the tumor to RT and a CR of the PVTT. Achieving an OR in both the tumor and the PVTT demonstrated a significant correlation with improved survival (P = 0.002). Progression of intrahepatic metastasis was affected not by CCRT but by the clinical features of the PVTT, particularly the initial PVTT site. PVTT response following CCRT seems prognostically significant. CR of the PVTT was associated with improved survival. Achieving an OR in both the tumor and PVTT was also associated with improved survival.

Keywords: complete response; concurrent chemoradiotherapy; hepatocellular carcinoma; portal vein tumor thrombosis.

Fig. 1.

Overall survival according to response status following PVTT (P = 0.048, by log-rank test). The solid line represents patients who achieved a CR (n = 14), and the dotted line represents those who did not achieve a CR (n = 86; PR + SD + PD).

Fig. 2.

Overall survival (OS) of four patient groups according to the tumor and PVTT response (CR + PR). The group that showed a response both in PVTT and tumor had the longest OS (n = 30; median, 16.7 months), which contrasted to OS in the group that showed response neither in tumor nor in PVTT (n = 27; median, 8.4 months). The OS difference in the two groups was statistically significant (P = 0.002, Log rank test), The OS in other groups, one showing a response in the tumor alone (n = 11; median, 16.0 months) and the other showing a response in the PVTT alone (n = 32; median, 11.4 months) was similar.

Fig. 3.

Overall survival according to overall response (OR) of patients with PVTT located in the main and first branch of the portal vein (P = 0.017). The solid line represents patients who achieved an OR (CR + PR, n = 52) and the dotted line represents those who did not achieve an OR (n = 30).