580 - Outcomes of Embolization for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: A Single-Institution Experience

Purpose: To evaluate outcomes of liver directed therapy with embolization in patients with hepatocellular carcinoma (HCC) and tumor extension into the portal veins (tumor thrombus), an institutional experience.

Materials and Methods: A single institution retrospective review was performed from January 2013 to January 2024 including patients with HCC and portal vein tumor thrombus who underwent endovascular liver directed therapies with TARE, TACE or Bland embolization. Patients with bland portal vein thrombus or tumor thrombus involving hepatic veins were excluded. 24 patients met inclusion criteria. 19 were male (79%) and 5 were female (21%) with a mean age of 67.2 yrs. 17 patients were Child-Pugh class A (70.1%) and 7 were class B. 9 patients had tumor thrombus involving the extrahepatic portal vein (ePVTT) (37.5%) and 15 had tumor thrombus in the intrahepatic portal veins (iPVTT) (62.5%). 9 patients (37.5%) received systemic therapy (2 received neoadjuvant while 7 received adjuvant therapy) while 15 did not (62.5%). Overall survival (OS) was determined from the date of the procedure. Survival sub analyses of patients with ePVTT vs iPVTT, Child-Pugh A vs. B, and systemic treatments vs no systemic treatments. Serious adverse events were recorded.

Results: OS for the 24 patients at 1 year was (45.8%), 2 year was (29.1%) and 3 year was (20.8%).OS in patients with iPVTT only (n=15) vs. ePVTT (n=9) at 1, 2 and 3 yrs was 60% vs. 22.2%(p=0.19), 40% vs. 11.1%(p=0.19) and 26.6% vs. 11.1%(p=0.61), respectively. OS in patients treated with adjuvant/neoadjuvant systemic therapy (n=9) vs no systemic therapy (n=15) at 1, 2 and 3 yrs was 66.6% vs 33.3% (p=0.23), 33.3% vs 26.6% (p=0.74) and 11.1% vs 20.0% (p=0.65), respectively. OS in Child-Pugh Class A vs. Class B at 1,2 and 3 years was 58.8% vs. 14.3% (p=0.07), 29.4% vs. 14.3% (p=0.63), and 17.6% vs 14.3% (p=1.0), respectively. Serious adverse events occurred in 22.2% of patients with ePVTT and in none of the patients with iPVTT.

Conclusion: Liver directed endovascular treatments give acceptable survival rates with few complications. Overall survival, although not statistically significant, showed a positive trend towards patients with iPVVT, Child-Pugh A, and those eligible for systemic treatment particularly at 1 year. Serious adverse events are more common in patients with ePVTT.

During the preparation of this work, the author(s) used [ChatGPT version 5] to help with statistical analyses.