Surgical management of hepatocellular carcinoma patients with portal vein thrombosis: The United States Safety Net and Academic Center Collaborative Analysis.
Carcinoma, Hepatocellular
/ pathology
Databases, Factual
Female
Follow-Up Studies
Hepatectomy
/ mortality
Humans
Liver Neoplasms
/ pathology
Male
Middle Aged
Portal Vein
/ physiopathology
Prognosis
Propensity Score
Retrospective Studies
Survival Rate
United States
Venous Thrombosis
/ physiopathology
cancer
hepatobiliary
outcomes
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
25
06
2020
revised:
11
10
2020
accepted:
17
10
2020
pubmed:
31
10
2020
medline:
5
3
2021
entrez:
30
10
2020
Statut:
ppublish
Résumé
Although consensus guidelines generally discourage any surgical management (ASM; i.e., resection and/or transplantation) in patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT), recent series from Asia have challenged this paradigm. Patients from the US Safety Net Collaborative database (2012-2014) with localized HCC and radiographically confirmed PVT were propensity-score matched based on demographic and clinicopathologic factors associated with receipt of ASM and overall survival (OS). OS was compared between patients undergoing ASM and those not selected for surgery. Of 1910 HCC patients, 207 (14.5%) had localized disease and PVT. The majority received either liver-directed therapies (LDTs; 34%) and/or targeted systemic therapies (36%). Twenty-one patients (10.1%) underwent ASM (resection [n = 11], transplantation [n = 10]); a third experienced any complication with no 30-day mortalities. Independent predictors of undergoing ASM were younger age, recent hepatology consultation, and lower model of end-stage liver disease (MELD) score. After matching for age, comorbidities, MELD, tumor size, receipt of LDT, or systemic therapy, OS was significantly longer for patients selected for ASM versus non-ASM patients (median not reached vs. 5.8 months, p < .001). In a large North American multi-institutional cohort, a minority of HCC patients with PVT were selected for ASM. Resection or transplantation was associated with improved survival and may have a role in the multimodality management in selected patients.
Sections du résumé
BACKGROUND
BACKGROUND
Although consensus guidelines generally discourage any surgical management (ASM; i.e., resection and/or transplantation) in patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT), recent series from Asia have challenged this paradigm.
METHODS
METHODS
Patients from the US Safety Net Collaborative database (2012-2014) with localized HCC and radiographically confirmed PVT were propensity-score matched based on demographic and clinicopathologic factors associated with receipt of ASM and overall survival (OS). OS was compared between patients undergoing ASM and those not selected for surgery.
RESULTS
RESULTS
Of 1910 HCC patients, 207 (14.5%) had localized disease and PVT. The majority received either liver-directed therapies (LDTs; 34%) and/or targeted systemic therapies (36%). Twenty-one patients (10.1%) underwent ASM (resection [n = 11], transplantation [n = 10]); a third experienced any complication with no 30-day mortalities. Independent predictors of undergoing ASM were younger age, recent hepatology consultation, and lower model of end-stage liver disease (MELD) score. After matching for age, comorbidities, MELD, tumor size, receipt of LDT, or systemic therapy, OS was significantly longer for patients selected for ASM versus non-ASM patients (median not reached vs. 5.8 months, p < .001).
CONCLUSION
CONCLUSIONS
In a large North American multi-institutional cohort, a minority of HCC patients with PVT were selected for ASM. Resection or transplantation was associated with improved survival and may have a role in the multimodality management in selected patients.
Identifiants
pubmed: 33125746
doi: 10.1002/jso.26282
pmc: PMC8221282
mid: NIHMS1640886
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
407-415Subventions
Organisme : NCI NIH HHS
ID : R01 CA161976
Pays : United States
Organisme : NCI NIH HHS
ID : T32CA211034
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002736
Pays : United States
Organisme : NCI NIH HHS
ID : T32 CA211034
Pays : United States
Organisme : NIH HHS
ID : UL1TR002736
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA240139
Pays : United States
Organisme : NCI NIH HHS
ID : 2R01CA161976-06
Pays : United States
Informations de copyright
© 2020 Wiley Periodicals LLC.
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