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DOI: 10.1055/s-0037-1612821
Liver vein infiltration in patients with hepatocellular carcinoma in a large German cohort
Publication History
Publication Date:
03 January 2018 (online)
Background:
Portal vein tumor thrombosis (PVTT) significantly impairs the prognosis of patients with hepatocellular carcinoma (HCC) and classifies them as advanced stage (BCLC-C). However, the relevance of liver vein infiltration (LVI) remains unclear. Aim of this study is to compare the prognosis of patients with different forms of macrovascular infiltration as this might influence the choice of treatment.
Methods:
1378 HCC-patients were extracted from the clinical registry of our tertiary referral center treated between 01/2005 – 01/2017. Macrovascular infiltration was diagnosed by re-evaluation of all available CT- or MRI-studies by two experienced radiologists in consensus reading. Overall survival (OS) was calculated from the date of initial diagnosis for all subgroups (no infiltration, PVTT, and LVI. In case of macrovascular infiltration, OS was additionally calculated from the date of its first appearance.
Results:
1341 patients could finally be included. 807 patients had no infiltration, 491 showed PVTT, and 43 an isolated LVI. OS from initial diagnosis was: 37.29, 6.53, and 16.03 months, respectively (p < 0.05). The OS calculated from the first appearance of macrovascular invasion was 4.9 for PVTT, and 7.33 for isolated LVI. The difference in OS was significantly different between these subgroups (p = 0.018).
Conclusions:
Overall, LVI was more common than expected. Often it occurs in combination with PVTT which leads to dismal prognosis. However, in the subgroup with isolated LVI, prognosis was significantly better compared to patients with PVTT. This renders the question if patients with isolated LVI should be classified as BCLC-C, like patients with PVTT, or whether BCLC-B might be more appropriate.
No infiltration |
Isolated LV infiltration |
Isolated PVTT |
PVTT LV infiltration |
|
n |
807 |
43 |
358 |
133 |
Survival from initial diagnosis (months) |
37.29 |
16.04 |
6.50 |
6.53 |
Survival from first appearance of vascular invasion (months) |
n.a. |
7.33 |
5.43 |
3.83 |