COMBINATION OF TACE WITH TARGETED MMUNOTHERAPY VERSUS TACE ALONE FOR HEPATOCELLULAR CARCINOMA PATIENTS WITH PORTAL VEIN TUMOR THROMBUS
Main Article Content
Keywords
hepatocellular carcinoma, portal vein tumor thrombosis, TACE, survival outcomes, mRECIST, Pakistan
Abstract
Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains one of the most difficult hepatobiliary malignancies to treat, particularly in regions such as Pakistan, where viral hepatitis is highly prevalent. Transarterial chemoembolization (TACE) is widely used for locoregional management, yet outcomes vary depending on tumor burden and liver function. This study evaluated treatment response, survival outcomes, and procedure-related complications of TACE in patients with HCC and segmental PVTT.
Methods:
This prospective observational study enrolled 80 patients with HCC and segmental PVTT confirmed on contrast-enhanced CT/MRI. Patients aged 18–80 years with Child-Pugh A or B liver function and ECOG ≤2 were included. TACE was performed using Lipiodol-doxorubicin emulsion followed by Gelfoam embolization. Tumor response was assessed using mRECIST at 4–6 weeks. Overall survival (OS) and progression-free survival (PFS) were analyzed using Kaplan–Meier curves with log-rank testing for subgroup comparisons. Complications were documented for safety assessment.
Results:
The mean age was 58.7 ± 9.2 years, and 82.5% were males. Hepatitis C virus infection was the most common etiology (71.3%). The objective response rate (complete plus partial response) was 58.8%. Median OS was 13.6 months, and median PFS was 8.9 months. One-year and two-year survival rates were 58.7% and 34.2% respectively. Patients with Child-Pugh A liver function had significantly better OS than Child-Pugh B (15.4 vs 11.1 months, p=0.021), and objective responders had markedly longer survival than non-responders (17.8 vs 10.2 months, p<0.001). Post-embolization syndrome occurred in 58.7% of patients and was managed conservatively. Major complications were infrequent, and no peri-procedural mortality was observed.
Conclusion:
TACE provided a favorable tumor response and meaningful survival benefit in patients with HCC and segmental PVTT, particularly in those with preserved liver function and early radiological response. The safety profile was acceptable, with most complications being minor and self-limiting. These findings support the continued use of TACE as an effective therapeutic option in populations with high viral hepatitis burden, such as Pakistan.
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Dr Sadia Abdullah
Consultant Clinical, Oncologist, SKMCH Lahore,
Dr Abdullah Saeed
Consultant Interventional Radiologist, Chairman & HOD, Department of Radiology, PKLI & RC Lahore
Dr Muhammad Ramzan
Consultant Radiologist, PKLI & RC Lahore
Dr Khoala Riaz
Clinical Fellow, Interventional Radiology, PKLI & RC Lahore
Dr Asim Ali
Clinical Fellow, Interventional Radiology, PKLI & RC Lahore
Dr Muhammad Usman Younas
Consultant Interventional Radiologist, PKLI & RC Lahore
