Rapid liver regeneration following PVE/HVE improves overall survival compared to PVE alone – A midterm analysis of the multicenter DRAGON 0 cohort

Background Hypertrophy-inducing procedures, such as portal vein embolization (PVE), improve future liver remnant (FLR) volume and function and help overcome limitations to resection. Mainly due to tumor progression while awaiting sufficient liver growth, 30-40% fail to achieve surgery after PVE. In the DRAGON 0 study, simultaneous portal and hepatic vein embolization (PVE/HVE) has shown to increase FLR-hypertrophy, kinetic growth rate and resectability substantially compared to PVE alone. The purpose of this study is to compare the 3-year overall survival after PVE/HVE versus PVE in patients undergoing liver resection for primary and secondary cancers of the liver.

Methods In this multicenter retrospective study, all DRAGON 0 centers provided 3-year follow-up data of all DRAGON 0-included PVE/HVE and PVE cases between 2016 and 2019. Kaplan-Meier analysis was performed to assess 3-year overall and recurrence-free survival. Factors affecting survival were analysed using uni- and multivariable cox regression analysis.

Results In total, 199 patients from 7 centers were included, of which 39 underwent PVE/HVE and 160 PVE alone. Groups differed in median age (p=0.008). As reported previously, PVE/HVE resulted in a significantly higher resection rate compared to PVE alone (92% vs. 68%; p=0.007). A significant higher 3-year overall survival was observed in the PVE/HVE group (PVE/HVE: not reached after 36 months vs. PVE: 20 months, p=0.004). PVE/HVE was an independent predictor of survival in uni- and multivariable analyses (hazard ratio: 0.46 (confidence interval: 0.27-0.76), p=0.003).

Conclusion Overall survival after PVE/HVE is better than after PVE alone in patients with primary and secondary liver tumors

Publication History

Article published online:
23 January 2024