Hepatectomy versus sorafenib for advanced hepatocellular carcinoma with macroscopic portal vein tumor thrombus: A bi‐institutional propensity‐matched cohort study

• Published in: Journal of hepato-biliary-pancreatic sciences 2023-03, Vol.30 (3), p.303-314
• Main Authors: Komatsu, Shohei, Ueshima, Kazuomi, Kido, Masahiro, Kuramitsu, Kaori, Tsugawa, Daisuke, Yanagimoto, Hiroaki, Toyama, Hirochika, Ku, Yonon, Kudo, Masatoshi, Fukumoto, Takumi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic Agents - therapeutic use; Blood clots; Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - surgery; Cohort analysis; Female; Hepatectomy; hepatocellular carcinoma; Humans; Inhibitor drugs; Japan - epidemiology; Liver cancer; Liver Neoplasms - drug therapy; Liver Neoplasms - mortality; Liver Neoplasms - surgery; Male; Middle Aged; Portal Vein - pathology; portal vein tumor thrombus; Propensity Score; sorafenib; Sorafenib - therapeutic use; Survival Rate; Targeted cancer therapy; Thrombosis - pathology; Thrombosis - surgery; Treatment Outcome
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.1236

Aim Sorafenib was previously considered a first‐line treatment for hepatocellular carcinoma (HCC) patients with macroscopic portal vein tumor thrombus (PVTT). This case‐matched analysis was performed to evaluate the best first‐line treatment for HCC in patients with macroscopic PVTT. Methods The HCC patients with Vp2 (PVTT invaded into a second‐order portal branch), Vp3 (first‐order portal branch), and Vp4 (main trunk or contralateral portal vein) PVTT who underwent hepatectomy and those treated with sorafenib were included. Treatment results were compared between the two modalities for each PVTT category, and a propensity analysis was performed for patients with Vp3 and Vp4 (Vp3/4). Results The median survival times (MSTs) of patients with Vp2, Vp3, and Vp4 PVTT who underwent hepatectomy were 21.4, 13.6, and 14.9 months, respectively; the MSTs for those with Vp2, Vp3, and Vp4 PVTT who received sorafenib treatment were 6.9, 5.5, and 3.6 months, respectively, with a significant difference. In a propensity‐matched cohort of patients with Vp3/4 PVTT (36 patients in each), the MST of patients who underwent hepatectomy (15.1 months) was significantly better than the patients treated with sorafenib (4.5 months). Conclusion Hepatectomy can be associated with prolonged survival in HCC patients with macroscopic PVTT. Komatsu et al. found that hepatectomy offered significantly better survival benefits with fewer treatment‐related complications than sorafenib in patients with hepatocellular carcinoma with macroscopic portal vein tumor thrombus. Optimizing the therapeutic time window by preventing the progression of portal vein tumor thrombus with hepatectomy can contribute to prolonged survival.