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. 2025 May 27;17(11):1794.
doi: 10.3390/cancers17111794.

Clinical Comparison Between Curative and Non-Curative Treatment for Hepatocellular Carcinoma with Hepatic Vein Invasion: A Nationwide Cohort Study

Sehyeon Yu  1 , Hye-Sung Jo  1 , Young-Dong Yu  1 , Yoo-Jin Choi  1 , Su-Min Jeon  1 , Dong-Sik Kim  1
Affiliations

Clinical Comparison Between Curative and Non-Curative Treatment for Hepatocellular Carcinoma with Hepatic Vein Invasion: A Nationwide Cohort Study

Sehyeon Yu et al. Cancers (Basel). .

Abstract

Background: Hepatocellular carcinoma (HCC) with hepatic vein invasion (HVI) is classified as advanced stage and palliative management is the primary treatment option. This study compared the long-term outcomes of curative and non-curative treatments in patients of HCC with HVI. Methods: Data were obtained from a retrospective multicenter cohort of the Korean Primary Liver Cancer Registry. We reviewed 18,315 patients newly diagnosed with HCC between 2008 and 2019. After propensity score matching based on the albumin-bilirubin (ALBI) score; tumor number, and tumor size, clinical outcomes were compared between the curative group (n = 42, 29.0%) undergoing surgical resection or local ablation and the non-curative group (n = 103, 71.0%) receiving other treatments. Results: Tumor burdens such as tumor number, maximum tumor size, levels of alpha-fetoprotein (AFP), and protein induced by absence of vitamin K or antagonist-II did not differ significantly between the groups (p = 0.672, p = 0.143, p = 0.153 and p = 0.651, respectively). In long-term outcomes, the overall survival (OS) and cancer-specific survival (CSS) were significantly better in the curative group compared to the non-curative group (p < 0.001, both). Multivariate analysis indicated that non-curative treatment, ALBI grade ≥ 2, and AFP ≥ 400 ng/mL were common risk factors for OS and CSS. Conclusions: Curative-intent treatment has the potential to significantly enhance long-term outcomes in selected patients of HCC with HVI who preserved liver function and performance status.

Keywords: curative-intent treatment; hepatic vein invasion; hepatocellular carcinoma.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study population. CTP, Child-Turcotte-Pugh; PS, performance status; HVI, hepatic vein invasion; HCC, hepatocellular carcinoma; ALBI, albumin-bilirubin.
Figure 2
Figure 2
Survival curves for long-term outcomes in the curative group and the non-curative group. (a) OS; (b) CSS. Abbreviations: OS, overall survival; CSS, cancer-specific survival.
Figure 3
Figure 3
Forest plot (Cox-multivariate) for (a) OS and (b) CSS. Abbreviations: ALBI, albumin-bilirubin grade; AFP, alpha-fetoprotein; OS, overall survival; CSS, cancer-specific survival.
Figure 3
Figure 3
Forest plot (Cox-multivariate) for (a) OS and (b) CSS. Abbreviations: ALBI, albumin-bilirubin grade; AFP, alpha-fetoprotein; OS, overall survival; CSS, cancer-specific survival.
Figure 4
Figure 4
Time-varying effects of risk factors on OS and CSS. (a) Time-varying effects of covariates on OS; (b) Time-varying effects of covariates on CSS. The figure shows the cumulative effects of selected covariates over time based on Aalen’s additive regression model. Solid lines represent the estimated cumulative effects, and shaded areas indicate the confidence intervals. Abbreviations: AFP, alpha-fetoprotein; ALBI, albumin-bilirubin grade; MELD, a model for end-stage liver disease; OS, overall survival; CSS, cancer-specific survival.
Figure 4
Figure 4
Time-varying effects of risk factors on OS and CSS. (a) Time-varying effects of covariates on OS; (b) Time-varying effects of covariates on CSS. The figure shows the cumulative effects of selected covariates over time based on Aalen’s additive regression model. Solid lines represent the estimated cumulative effects, and shaded areas indicate the confidence intervals. Abbreviations: AFP, alpha-fetoprotein; ALBI, albumin-bilirubin grade; MELD, a model for end-stage liver disease; OS, overall survival; CSS, cancer-specific survival.
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