• chemoembolization
• extrahepatic metastasis
• hepatocellular carcinoma
• liver cancer
• vascular invasion

• Humans
• Chemoembolization, Therapeutic/methods
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/mortality
• Liver Neoplasms/therapy
• Liver Neoplasms/pathology
• Liver Neoplasms/mortality
• Neoplasm Invasiveness
• Treatment Outcome
• Neoplasm Metastasis

• Oxaliplatin
• Temperature-sensitive liquid embolic agent
• Transcatheter arterial chemoembolization
• VX2 gastric cancer

• Animals
• Rabbits
• Oxaliplatin
• Carcinoma, Hepatocellular
• Liver Neoplasms/therapy
• Chemoembolization, Therapeutic/methods
• Stomach Neoplasms/drug therapy
• Temperature
• Vascular Endothelial Growth Factor A

• 234400510027 Central Plains Scholars Workstation in 2022 (Workstation numbers [ZYGZZ2022087])
• 224400510024 Central Plains Scholars Workstation in 2021 (Workstation numbers [ZYGZZ2021054])

• Humans
• Carcinoma
• Biliary Tract Neoplasms

• Asian countries
• guideline
• hepatocellular carcinoma
• overall survival
• treatment option

• bland embolization
• drug-eluting beads–transarterial chemoembolization
• hepatic artery infusion
• hepatocellular carcinoma
• selective internal radioembolization therapy
• transarterial chemoembolization

• UL1 TR001863 NCATS NIH HHS

The efficacy and safety of stereotactic body radiotherapy (SBRT) plus transcatheter arterial chemoembolization (TACE) versus SBRT or TACE alone(monotherapy) for hepatocellular carcinoma (HCC) patients with portal vein tumour thrombus (PVTT) remains controversial. This meta-analysis was performed to provide more powerful evidence for clinical strategies in inoperable HCC with PVTT.

We searched the PubMed, EMBASE, Web of Science, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), VIP Journal Integration Platform (VIP), and WanFang databases for eligible studies. We pooled the results of 1- and 2-year overall survival rates (OSRs), objective response rates (ORRs), and adverse events (AEs) between the two groups and performed a subgroup meta-analysis for study type, control group, treatment order, and the interval between SBRT and TACE.

Nine studies with 10 cohorts involving 938 patients were included in our meta-analysis. SBRT plus TACE yielded significantly higher 1-year OSR (RR, 1.52[95% CI, 1.33–1.74]), 2-year OSR (RR, 2.00 [95% CI: 1.48–2.70]), ORR (RR = 1.22 [95% CI, 1.08–1.37]), and a lower progression disease (PD) rate (RR = 0.45 [95% CI:0.26–0.79]) than monotherapy. No significant differences were detected in CR, PR, SD, or AEs between the two groups. Subgroup analysis regarding study type, control group, and treatment order indicated that compared with monotherapy, the combination of SBRT with TACE was associated with an increase in 1- and 2-year OSRs but not in ORR. In regard to the interval between SBRT and TACE, subgroup analysis found that the combination therapy for patients with an SBRT-TACE interval <28 days was preferable to monotherapy in the 1- and 2-year OSRs, and ORR. However, for patients with an SBRT-TACE interval ≥28 days, no obvious distinctions were observed in the 1-year OSR, 2-year OSR, or ORR between the two groups.

The combination of SBRT with TACE appears to be better than monotherapy in treating HCC with PVTT and should be recommended for inoperable HCC patients with PVTT.

• Carcinoma, Hepatocellular/drug therapy
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic/adverse effects
• Humans
• Liver Neoplasms/drug therapy
• Liver Neoplasms/therapy
• Portal Vein/pathology
• Radiosurgery
• Thrombosis/etiology
• Treatment Outcome

• Chinese Medical Hand in Hand Project Committee & Beijing Medical Award Foundation
• Science Foundation for Distinguished Young Scholars of Guangxi University of Chinese Medicine
• Basic Ability Enhancement Program for Young and Middle-aged Teachers in Higher Education Institutions of Guangxi

• Bridging
• Devascularization
• Downstaging
• Liver neoplasms
• Survival

Hepatocellular carcinoma (HCC) accounts for approximately 75–90% of primary liver cancers and is the sixth most common cancer and the third leading cause of cancer-related deaths worldwide. In the HIV-positive population, the risk of HCC is approximately four times higher than in the general population, with higher cancer-specific mortality than in HIV-negative patients. In most cases, HCC diagnosis is made in patients younger than the HIV-negative population and in the intermediate-advanced stage, thus limiting the therapeutic possibilities. Treatment choice in HIV-positive patients with HCC is subject to cancer staging, liver function and health status, as for HIV-negative and non-HIV-negative HCC patients. There are relatively few studies on the efficacy and safety in HIV-positive patients to date in loco-regional treatments for HCC. So far, literature shows that curative treatments such as radiofrequency ablation (RFA) have no significant differences in overall survival between HIV-positive and HIV-negative patients, as opposed to palliative treatments such as TACE, where there is a significant difference in overall survival. Although it can be assumed that the most recently discovered loco-regional therapies are applicable to HIV-positive patients with HCC in the same way as HIV-negative patients, further studies are needed to confirm this hypothesis. The purpose of our review is to evaluate these treatments, their efficacy, effectiveness, safety and their applicability to HIV-positive patients.

The purpose of this study was to compare the efficacy and safety of transarterial chemoembolization (TACE) plus sorafenib with those of TACE alone in patients with locally advanced hepatocellular carcinoma (HCC). Treatment-naïve patients with preserved hepatic reserve (Child–Pugh score ≤ 7) who received TACE plus sorafenib (n = 91) or TACE alone (n = 109) for locally advanced HCC with macrovascular invasion were retrospectively evaluated. Propensity score matching (PSM) was used to correct selection bias, and 63 pairs were created. In the entire study population, the median progression-free survival (PFS) and overall survival (OS) with TACE plus sorafenib were better than those with TACE alone. After PSM, the median PFS (7.0 vs. 4.3 months; p = 0.017) and OS (17.5 vs. 12.8 months; p = 0.049) were again significantly longer with TACE plus sorafenib than with TACE alone. Stratified Cox regression analysis and doubly robust estimation revealed that treatment type was significantly associated with both PFS and OS. In the subgroup analysis, TACE plus sorafenib did not show a significant survival benefit for patients with main portal vein or inferior vena cava invasion. Major complications were similar in both groups (p = 0.330). In conclusion, TACE plus sorafenib showed better survival outcomes than TACE alone in patients with locally advanced HCC.

• hepatocellular carcinoma
• macroscopic vascular invasion
• sorafenib
• transarterial chemoembolization

• hepatocellular carcinoma
• portal vein tumor thrombosis
• transarterial chemoembolization

• Combined modality therapy
• Hepatocellular carcinoma
• Immunotherapy
• Locoregional therapy
• Transarterial chemoembolization
• Transarterial radioembolization

• Hepatocellular carcinoma
• Microvascular invasion
• Recurrence
• Resection
• Tumor biology

• Carcinoma, Hepatocellular/surgery
• Hepatectomy
• Humans
• Liver Neoplasms/surgery
• Neoplasm Recurrence, Local
• Portal Vein/surgery
• Prognosis
• Retrospective Studies
• Venous Thrombosis/etiology
• Venous Thrombosis/surgery

• Liver transplantation (LT)
• liver resection (LR)
• portal vein
• tumour thrombus

• concurrent chemoradiotherapy
• hepatocellular carcinoma
• portal vein invasion
• prognosis
• response

The study aimed to establish a prognostic prediction model and an artificial neural network (ANN) model to determine who will benefit from transarterial chemoembolization (TACE) monotherapy for patients with hepatocellular carcinoma (HCC) invading portal vein.

Treatment-naïve patients with HCC and portal vein invasion who were treated with TACE monotherapy at hospital A as training cohort and hospital B as validation cohort were included. The primary endpoint was overall survival (OS). In training cohort, independent risk factors associated with OS were identified by univariate and multivariate analysis. The prognostic prediction (PP) and ANN models based on the independent risk factors were established to find out who will benefit most from TACE monotherapy. The type of portal vein tumor thrombosis was classified based on the Cheng’s Classification. The accuracy of the models was validated in validation cohort.

Totally, 242 patients (training cohort: n ​= ​159; validation cohort: n ​= ​83) were included. The median OS was 7.1 and 8.5 months in training and validation cohort, respectively. In training cohort, the PP model was established based on the following five independent risk factors: Cheng’s Classification, Eastern Cooperative Oncology Group score, maximum tumor size, number of HCC nodules, and Child-Pugh stage. PP score of 17.5 was identified as cut-off point and patients were divided into two groups by PP score <17.5 and >17.5 in survival benefit and prognostication (8.8 vs. 5.5 months; P ​< ​0.001). These five factors were included and ranked based on the importance associated with OS in the ANN model. Both of the two models received high accuracy after validation.

Portal vein invaded HCC patients with PP score <17.5 may benefit most from TACE monotherapy. For these patients, TACE monotherapy should be considered.

• Artificial neural network
• Hepatocellular carcinoma
• Portal vein tumor thrombosis
• Prognostic
• Transarterial chemoembolization

The benefits of transarterial chemoembolization plus sorafenib (TACE-S) in hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) remain controversial. We compared the effectiveness and safety of TACE-S and TACE for HCC with PVTT.

The Cochrane Library, PubMed, EMBASE, Chinese National Knowledge Infrastructure, VIP, Wan Fang, and Sino Med databases were systematically searched for studies of HCC with PVTT treated using TACE-S. Two authors independently extracted study outcomes, including overall survival (OS), time to progression (TTP), objective response (tumor response) and adverse events (AEs).

Eight high-quality, retrospective studies with 1091 patients (TACE-S=356, TACE=735) were included in the review. Five retrospective studies with 973 patients (TACE-S=238, TACE=735) were included in the meta-analysis. The objective response rate (ORR, OR=3.59, 95% CI=1.74–7.39; I²=21%, P=0.0005) and disease control rate (DCR, OR=4.72, 95% CI=1.75–12.72; I²=56%, P=0.002) favored TACE-S. TACE-S significantly increased 6-month OS (OR=3.47; 95% CI=2.47–4.89; I²=0%, P < 0.00001) and 1-year OS (OR=3.10; 95% CI=2.22–4.33; I²=41%, P < 0.00001). The hazard ratio (HR) for OS (HR=0.62; 95% CI=0.51–0.75; I²=30%, P < 0.00001) also indicated that TACE-S was superior to TACE. TACE-S with PVTT had better outcomes in the first-order portal vein branch and lower-order portal vein branches than in the main portal vein and upper branches to superior mesenteric vein. The most common AEs were hand-foot skin reaction (HFSR, 178; 73%), diarrhea (142; 58%) and alopecia (76; 31%); AEs of grade 3/4 were rare.

TACE-S may improve OS, ORR, TTP and DCR for HCC patients with PVTT compared to TACE.

• PVTT
• TACE
• combined treatment
• hepatocellular carcinoma
• meta-analysis
• sorafenib
• systematic review

The current study aimed to evaluate the efficacy and outcomes of three-dimensional conformal radiotherapy (3DCRT) combined with transarterial chemoembolization (TACE) for treating patients with hepatocellular carcinoma involving portal vein tumor thrombus.

Between January 2000 and December 2013, a total of 182 hepatocellular carcinoma patients with portal vein tumor thrombus were retrospectively analyzed: 68 patients were treated by 3DCRT alone (group A), 74 by TACE alone (group B), and 40 by a combination of 3DCRT + TACE (group C). The overall survival (OS) of the three groups was compared using the Kaplan–Meier method. The independent predictors of survival were identified using multivariate analysis.

The total effective rate (complete response + partial response) among all patients was 44% (80/182). The objective response rate (complete response + partial response) was higher in group C than in group A or B, but the differences were not significant. OS rates at 1, 2, and 3 years were significantly higher in group C than in group A or B (P<0.05), while OS rates were similar between groups A and B. Multivariate analysis identified serum levels of alpha-fetoprotein <400 ng/mL and the use of 3DCRT + TACE as independent predictors of better OS.

These results suggest that combining 3DCRT with TACE may provide better OS than either technique alone in hepatocellular carcinoma patients with portal vein tumor thrombus.

• hepatocellular carcinoma
• overall survival
• portal vein tumor thrombus
• three-dimensional conformal radiotherapy
• transarterial chemoembolization

Patients with advanced hepatocellular carcinoma (HCC) showing portal vein tumor thrombosis (PVTT) have an extremely poor prognosis. According to treatment guidelines, the only option for HCC patients with PVTT is sorafenib chemotherapy. However, in Asia, various treatments have been attempted and possible prolongation of overall survival has been repeatedly reported. We herein report the first case of a patient with an initially unresectable advanced HCC with PVTT who underwent curative hepatectomy after sorafenib and transcatheter arterial chemoembolization (TACE) showing complete histological response. Two months after induction with sorafenib, a significant decrease in serum alpha-fetoprotein level was observed and computed tomography imaging showed a significant decrease in tumor size. Because of remaining PVTT, TACE and curative resection were performed. The combination of sorafenib and TACE may be an effective treatment for HCC patients with PVTT.

• Hepatocellular carcinoma
• Sorafenib
• Complete response
• Portal vein tumor thrombosis
• Transcatheter arterial chemoembolization

• Aged
• Angiography, Digital Subtraction
• Antineoplastic Agents/therapeutic use
• Carcinoma, Hepatocellular/complications
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic
• Hepatectomy
• Humans
• Liver Neoplasms/complications
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Male
• Niacinamide/analogs & derivatives
• Niacinamide/therapeutic use
• Phenylurea Compounds/therapeutic use
• Phlebography/methods
• Portal Vein/diagnostic imaging
• Protein Kinase Inhibitors/therapeutic use
• Sorafenib
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome
• Venous Thrombosis/diagnostic imaging
• Venous Thrombosis/etiology
• Venous Thrombosis/therapy

• Liver cancer
• Radiotherapy
• Surgery
• Targeted agent
• Vascular invasion

• Carcinoma, Hepatocellular/complications
• Chemoembolization, Therapeutic
• Combined Modality Therapy
• Humans
• Liver Neoplasms/complications
• Portal Vein/surgery
• Stents
• Thrombectomy
• Venous Thrombosis/classification
• Venous Thrombosis/etiology
• Venous Thrombosis/therapy

Although the current standard treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is sorafenib, many previous studies have established the need for a reliable local modality for PVTT control, which is a major cause of liver function deterioration and metastasis. Additionally, there is growing evidence for the prognostic significance of PVTT classification according to the location of tumor thrombosis. Favorable outcomes can be obtained by applying local modalities, including surgery or transarterial chemoembolization, especially in second-order or distal branch PVTT. Rapid control of PVTT could maintain or improve liver function and reduce intrahepatic as well as distant metastasis. Radiotherapy (RT) is one of the main locoregional treatment modalities in oncologic fields, but has rarely been used in HCC because of concerns regarding hepatic toxicity. However, with the development of advanced techniques, RT has been increasingly applied in HCC management. Randomized studies have yet to definitively prove the benefit of RT, but several comparative studies have justified the application of RT in HCC. The value of RT is especially noticeable in HCC with PVTT; several prospective and retrospective studies have reported favorable outcomes, including a 40% to 60% objective response rate and median overall survival of 15 mo to 20 mo in responders. In this review, we evaluate the role of RT as an alternative local modality in HCC with PVTT.

• Hepatocellular carcinoma
• Portal vein tumor thrombosis
• Radiotherapy
• Local modality
• Alternative

• Carcinoma, Hepatocellular/complications
• Carcinoma, Hepatocellular/radiotherapy
• Chemoradiotherapy
• Humans
• Liver Neoplasms/complications
• Liver Neoplasms/radiotherapy
• Portal Vein
• Radiotherapy, Intensity-Modulated
• Venous Thrombosis/therapy

• Hepatocellular carcinoma
• Transarterial chemoembolization
• Transarterial radioembolization

The natural history of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is dismal (approximately 2-4 mo), and PVTT is reportedly found in 10%-40% of HCC patients at diagnosis. According to the Barcelona Clinic Liver Cancer (BCLC) Staging System (which is the most widely adopted HCC management guideline), sorafenib is the standard of care for advanced HCC (i.e., BCLC stage C) and the presence of PVTT is included in this category. However, sorafenib treatment only marginally prolongs patient survival and, notably, its therapeutic efficacy is reduced in patients with PVTT. In this context, there have been diverse efforts to develop alternatives to current standard systemic chemotherapies or combination treatment options. To date, many studies on transarterial chemoembolization, 3-dimensional conformal radiotherapy, hepatic arterial chemotherapy, and transarterial radioembolization report better overall survival than sorafenib therapy alone, but their outcomes need to be verified in future prospective, randomized controlled studies in order to be incorporated into current treatment guidelines. Additionally, combination strategies have been applied to treat HCC patients with PVTT, with the hope that the possible synergistic actions among different treatment modalities would provide promising results. This narrative review describes the current status of the management options for HCC with PVTT, with a focus on overall survival.

• Hepatocellular carcinoma
• Portal vein tumor thrombosis
• Sorafenib
• Transarterial chemoembolization
• Transarterial radioembolization
• Hepatic arterial chemotherapy
• Radiotherapy

• ADAM17 Protein/administration & dosage
• Carcinoma, Hepatocellular/complications
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic
• Combined Modality Therapy
• Embolization, Therapeutic
• Humans
• Liver Neoplasms/complications
• Liver Neoplasms/therapy
• Niacinamide/administration & dosage
• Niacinamide/analogs & derivatives
• Niacinamide/therapeutic use
• Phenylurea Compounds/administration & dosage
• Phenylurea Compounds/therapeutic use
• Portal Vein
• Radiotherapy, Conformal
• Sorafenib
• Venous Thrombosis/etiology
• Venous Thrombosis/therapy

• 90Y radioembolization
• hepatocellular carcinoma
• transarterial chemoembolization

• Early response
• Hepatic arterial infusion chemotherapy
• Hepatocellular carcinoma
• Overall survival
• Portal vein thrombosis
• Progression-free survival

• Intrahepatic cholangiocarcinoma (ICC)
• embolization
• survival
• unresectable

• Hepatocellular carcinoma (HCC)
• Portal vein tumor thrombus (PVTT)
• Therapeutic strategy

• Carcinoma, Hepatocellular/therapy
• Catheter Ablation
• Chemoembolization, Therapeutic
• Combined Modality Therapy
• Hepatectomy/methods
• High-Intensity Focused Ultrasound Ablation
• Humans
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Neoplastic Cells, Circulating
• Portal Vein/pathology
• Prognosis
• Quality of Life
• Radiotherapy, Conformal
• Thrombosis/surgery
• Treatment Outcome

AIM: To compare survival and recurrence in hepatocellular carcinoma (HCC) patients who did or did not receive adjuvant transarterial chemoembolization (TACE).

METHODS: A consecutive sample of 229 patients who underwent curative resection between March 2007 and March 2010 in our hospital was included. Of these 229 patients, 91 (39.7%) underwent curative resection followed by adjuvant TACE and 138 (60.3%) underwent curative resection alone. In order to minimize confounds due to baseline differences between the two patient groups, comparisons were conducted between propensity score-matched patients. Survival data and recurrence rates were compared using the Kaplan-Meier method. Independent predictors of overall survival and recurrence were identified using Cox proportional hazard regression.

RESULTS: Among 61 pairs of propensity score-matched patients, the 1-, 2-, and 3-year overall survival rates were 95.1%, 86.7%, and 76.4% in the TACE group and 86.9%, 78.5%, and 73.2% in the control group, respectively. At the same time, the TACE and control groups also showed similar recurrence rates at 1 year (13.4% vs 24.8%), 2 years (30.6% vs 32.1%), and 3 years (40.1% vs 34.0%). Multivariate Cox regression identified serum alpha-fetoprotein level ≥ 400 ng/mL and tumor size > 5 cm as independent risk factors of mortality (P < 0.05).

CONCLUSION: As postoperative adjuvant TACE does not improve overall survival or reduce recurrence in HCC patients, further study is needed to clarify its clinical benefit.

• Hepatocellular carcinoma
• Overall survival
• Transarterial chemoembolization
• Curative resection
• Recurrence

• Adult
• Carcinoma, Hepatocellular/blood
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic/adverse effects
• Chemoembolization, Therapeutic/mortality
• Chemotherapy, Adjuvant
• Chi-Square Distribution
• China
• Disease-Free Survival
• Female
• Hepatectomy/adverse effects
• Hepatectomy/mortality
• Humans
• Kaplan-Meier Estimate
• Liver Neoplasms/blood
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Recurrence, Local
• Propensity Score
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome
• Tumor Burden
• alpha-Fetoproteins/analysis