Clinical Research Papers:
The degree of hepatic arterial blood supply of portal vein tumor thrombus in patients with hepatocellular carcinoma and its impact on overall survival after transarterial chemoembolization
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Juxian Sun1,*, Jie Shi1,*, Bin Huang2,*, Fantian Cheng1,3, Weixing Guo1, Wan Yee Lau1,4 and Shuqun Cheng1
1Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
2Department of Imaging, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
3Department of Hepatopancreatobiliary Surgery I, The Central Hospital of Wuhan, Tongji Medical University of Science and Technology, Wuhan, China
4Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
*These authors contributed equally to this work
Shuqun Cheng, email: [email protected]
Keywords: blood supply, portal vein tumor thrombus, hepatocellular carcinoma, TACE
Received: February 08, 2017 Accepted: June 29, 2017 Published: August 01, 2017
Purpose: To investigate the degree of arterial blood supply of portal vein tumor thrombus (PVTT) in patients with hepatocellular carcinoma (HCC), and to evaluate its impact on overall survival after transarterial chemoembolization using lipiodol +/– gelatin sponge particles (TACE).
Results: Of the 10 patients who underwent surgery, the number of patients with good/mild/poor staining of PVTT by methylene blue were 3, 4, and 3, respectively. The degrees of methylene blue staining in these patients correlated well with the degrees of accumulation of lipiodol in PVTT in these patients, i.e. good/mild/poor in 3, 4, and 3 patients, respectively. For the 77 patients who underwent TACE as treatment, they were divided into 2 groups: good accumulation of lipiodol (n = 27) and mild/poor accumulation of lipiodol (n = 50) on CT. The overall median survival between the 2 groups was 10.0 months vs 2.7 months, (p < 0.001). Multi-variable analysis showed degree accumulation of Lipiodol (OR, 2.057; 95% CI,1.414–2.993; p < 0.001) to be an independent prognostic factor.
Patients and Methods: Patients with HCC with PVTT who underwent surgical resection received preoperative TACE. At operation, arterial injection of methylene blue into the common hepatic artery was carried out. During the study period, other patients with unresectable HCC with PVTT were treated with TACE.
Conclusion: In about 1/3 of patients with HCC with PVTT, the arterial blood supply from the hepatic artery to the PVTT was good. These patients responded better to TACE than those patients with mild/poor arterial supply.
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