ORIGINAL ARTICLE – HEPATOBILIARY TUMORS
Postoperative Adjuvant Trans-Arterial Chemoembolization
for Patients with Hepatocellular Carcinoma and Portal Vein
Shuang Liu, PhD
, Lei Guo, PhD
, Hui Li, PhD
, Bo Zhang, PhD
, Jialei Sun, MD
, Chenghao Zhou, PhD
Jian Zhou, PhD
, Jia Fan, PhD
, and Qinghai Ye, PhD
Department of Liver Surgery, Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China;
Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China
Background. It remains uncertain whether patients with
hepatocellular carcinoma (HCC) and portal vein tumor
thrombus (PVTT) beneﬁt from postoperative adjuvant
trans-arterial chemoembolization (PA-TACE).
Methods. We retrospectively identiﬁed 540 patients to
form the crude cohort and adopted propensity score
matching analysis to assemble another cohort of 464
patients with similar baseline characteristics. Univariate
and multivariate Cox analyses were performed in
exploratory subgroups to identify the independent effect of
PA-TACE on overall survival (OS).
Results. In the overall study population, univariate anal-
ysis showed PA-TACE was associated with longer OS
[odds ratio (OR) = 0.55, p = 0.001], and stratiﬁed analyses
indicated an interaction between PVTT types and PA-
TACE on OS (p = 0.057 for interaction). After matching,
all of the characteristics were well balanced between the
PA-TACE and control groups (all p [ 0.05). Multivariate
Cox analysis validated that the protective role of PA-TACE
was signiﬁcant greater with the expansion of PVTT (type I,
OR 0.66; type II, OR 0.33; and type III, OR 0.33, respec-
tively, p = 0.011 for interaction). There also was evidence
of treatment effect modiﬁcation by PVTT type in the crude
cohort (type I, OR 0.60; type II, OR 0.32; and type III, OR
0.32, respectively, p = 0.011 for interaction).
Conclusions. In patients with HCC and PVTT, PA-TACE
was associated with a lower risk of death, particularly,
among those with PVTT involving right/left or main portal
vein, after excluding patients who were unsuitable for this
procedure at 1 month after surgery.
Portal vein tumor thrombus (PVTT) is one of the most
difﬁcult and common situations that must be treated in
patients with hepatocellular carcinoma (HCC).
occurrence of PVTT always represents signiﬁcant negative
prognostic factors for patients with HCC.
Clinic Liver Cancer staging system classiﬁes these patients
as advanced stage (or Stage C) and recommends sorafenib
as the standard treatment.
Actually, results from a phase
III, randomized, controlled trial in Asia showed that this
treatment increased the median overall survival only to
With advances in treatment modalities, many
studies have revealed that a surgical approach for HCC
with PVTT is feasible and may offer a chance for long-
However, the high incidence of tumor
recurrence and metastasis remains a signiﬁcant barrier for
Therefore, surgical multimodality
treatment is now being recommended by more liver cen-
ters, including our center.
As a palliative treatment, transarterial chemoemboliza-
tion (TACE) can be used as an adjuvant management
approach to improve the effects of surgical resection,
although the results are controversial.
Electronic supplementary material The online version of this
article (https://doi.org/10.1245/s10434-018-6438-1) contains supple-
mentary material, which is available to authorized users.
Shuang Liu, Lei Guo, and Hui Li contributed equally to this work.
Ó Society of Surgical Oncology 2018
First Received: 23 July 2017;
Published Online: 4 May 2018
J. Fan, PhD
Q. Ye, PhD
Ann Surg Oncol (2018) 25:2098–2104