Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2021; 27(13): 1330-1340
Published online Apr 7, 2021. doi: 10.3748/wjg.v27.i13.1330
Factors influencing the short-term and long-term survival of hepatocellular carcinoma patients with portal vein tumor thrombosis who underwent chemoembolization
Ke-Li Chen, Jian Gao
Ke-Li Chen, Jian Gao, Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Author contributions: Chen KL was responsible for designing the study, collecting data, analyzing data and writing the paper; Gao J was responsible for designing the study and guiding important content of the article.
Supported by National Natural Science Foundation of China, No. 81572888.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University (No. 2020-122).
Informed consent statement: All study participants gave their informed consent prior to study enrollment (by written or verbal).
Conflict-of-interest statement: None declared.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Gao, PhD, Chief Doctor, Professor, Department of Gastro-enterology and Hepatology, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing 400010, China.982213482@qq.com
Received: January 9, 2021
Peer-review started: January 9, 2021
First decision: February 11, 2021
Revised: February 19, 2021
Accepted: March 7, 2021
Article in press: March 7, 2021
Published online: April 7, 2021
Processing time: 79 Days and 18 Hours
Abstract
BACKGROUND

The factors affecting the short-term and long-term prognosis of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) receiving transarterial chemoembolization (TACE) are still unclear.

AIM

To clarify the predictors correlated with the short-term and long-term survival of HCC patients with PVTT who underwent TACE.

METHODS

The medical records of 181 HCC patients with PVTT who underwent TACE at the Second Affiliated Hospital of Chongqing Medical University from January 2015 to July 2019 were retrospectively analyzed. We explored the short-term and long-term prognostic factors by comparing the preoperative indicators of patients who died and survived within 3 mo and 12 mo after TACE. Multivariate analyses were conducted using logistic regression. The area under the receiver operating characteristic curve (area under curve) was used to evaluate the predictive ability of the factors related to the short-term and long-term prognosis.

RESULTS

The median survival time was 4.8 mo (range: 2.5-8.85 mo). The 3 mo, 6 mo, and 12 mo survival rates were 68.5%, 38.7%, and 15.5%, respectively. In multivariable analysis, total bilirubin, sex, and aspartate aminotransferase (AST) were closely linked to short-term survival. When AST ≥ 87 U/L and total bilirubin ≥ 16.15 µmol/L, the 3-mo survival rate after TACE was reduced significantly (P < 0.05). AST had the best predictive ability, followed by total bilirubin, while sex had the worst predictive ability for short-term survival area under curve: 0.763 (AST) vs 0.707 (total bilirubin) vs 0.554 (sex)]. The long-term survival outcome was significantly better in patients with a single lesion than in those with ≥ three lesions (P = 0.009). Patients with massive block HCC had a worse long-term survival than patients with nodular and diffuse HCC (P = 0.001).

CONCLUSION

AST, total bilirubin, and sex are independent factors associated with short-term survival. The number of tumors and the gross pathological type of tumor are related to the long-term outcome.

Keywords: Transarterial chemoembolization; Hepatocellular carcinoma; Portal vein tumor thrombosis; Survival; Prognostic factors

Core Tip: It is unclear which factors affect the short-term and long-term prognosis of hepatocellular carcinoma patients with portal vein tumor thrombosis receiving transarterial chemoembolization. In our research, we clarified the predictors correlated with the short-term and long-term survival of hepatocellular carcinoma patients with portal vein tumor thrombosis who underwent transarterial chemoembolization by analyzing preoperative indicators. Results showed that aspartate aminotransferase, sex, and total bilirubin were independent factors associated with short-term survival. The number of lesions and the gross pathological type of tumor were related to the long-term outcome.