Tailored treatment of patients with hepatocellular carcinoma with portal vein invasion: Experience from a multidisciplinary hepatobiliary tumor program within a NCI comprehensive cancer center

Sarah Walcott-Sapp, Willscott (Scott) Naugler, Jeong Youn Lim, Jesse Wagner, Susan Orloff, Khashayar Farsad, Kenneth Kolbeck, John Kaufman, Erin Maynard, C. Kristian Enestvedt, Skye Mayo, Kevin Billingsley

Research output: Contribution to journalArticle

1 Scopus citations


Background: Hepatocellular carcinoma (HCC) with portal vein invasion (PVI) has a poor prognosis with limited treatment options. Intra-arterial brachytherapy (IAB) and transarterial chemoembolization (TACE) yield local control but risk accelerating liver dysfunction. The outcomes, survival, and safety of selective liver-directed treatment are reported. Methods: Thirty-seven consecutive patients with HCC and PVI treated between 2009 and 2015 were reviewed from a prospectively collected database. Univariate analysis, Kaplan-Meier plots using the log-rank method, and multivariate analyses were performed. Statistical significance was defined as P<0.05. Overall survival was reported in months (median; 95% CI). Results: Most patients (59%) had PVI identified at initial HCC diagnosis. The liver-directed therapy group (n=22) demonstrated a survival advantage versus the systemic/supportive care group (n=14) [23.6 (5.8, 30.9) vs. 6.0 (3.5, 8.8) months]. Patients indicated for liver directed therapy had unilateral liver involvement (100% vs. 43%, P<0.0001), lower median alkaline phosphatase (105.5 vs. 208.0, P=0.002), and lower mean Child-Turcotte-Pugh (CTP) score (5.9 vs. 7.2, P=0.04) and tolerated treatment without serious complications. Conclusions: In HCC patients presenting with PVI, liver-directed therapy was safely performed in patients with limited venous involvement and preserved liver function. Liver-directed therapy extended survival for these patients indicated for palliative chemotherapy by traditional guidelines.

Original languageEnglish (US)
Pages (from-to)1074-1083
Number of pages10
JournalJournal of Gastrointestinal Oncology
Issue number6
StatePublished - Dec 1 2018



  • Hepatocellular carcinoma (HCC)
  • Portal vein invasion (PVI)
  • Portal vein tumor thrombus
  • Transarterial chemoembolization (TACE)
  • Transarterial radioembolization

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

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