Moon Haeng Hur, Yuri Cho, Do Young Kim, Jae Seung Lee, Gyoung Min Kim, Hyo-Cheol Kim, Dong Hyun Sinn, Dongho Hyun, Han Ah Lee, Yeon Seok Seo, In Joon Lee, Joong-Won Park, Yoon Jun Kim
Clin Mol Hepatol 2023;29(3):763-778. Published online May 30, 2023
Background/Aims Transarterial radioembolization (TARE) has shown promising results in treating advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). However, whether TARE can provide superior or comparable outcomes to tyrosine kinase inhibitor (TKI) in patients with HCC and PVTT remains unclear. We compared the outcomes of TARE and TKI therapy in treatment-naïve patients with locally advanced HCC and segmental or lobar PVTT.
Methods This multicenter study included 216 patients initially treated with TARE (n=124) or TKI (sorafenib or lenvatinib; n=92) between 2011 and 2021. Baseline characteristics were balanced using propensity score matching (PSM) or inverse probability of treatment weighting (IPTW). The primary outcome was overall survival (OS). The secondary outcomes included progression-free survival (PFS) and objective response rate (ORR).
Results In the unmatched cohort, the median OS of the TARE and TKI groups were 28.2 and 7.2 months, respectively (p<0.001), and the TARE group experienced significantly and independently longer OS compared to the TKI group (adjusted hazard ratio=0.41, 95% confidence interval=0.28–0.60, p<0.001). Similar results were observed in the study cohorts balanced with IPTW (p=0.003) or PSM (p=0.004). Although PFS was comparable between the two groups, the TARE group showed a trend of prolonged PFS in a subpopulation of patients with Vp1 or Vp2 PVTT (p=0.052). In the matched cohorts, the ORR of the TARE group was 53.0–56.7%, whereas that of the TKI group was 12.3–15.0%.
Conclusions For patients with advanced HCC with segmental or lobar PVTT and well-preserved liver function, TARE may provide superior OS compared to sorafenib or lenvatinib.
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Liver cancer is the sixth most common cancer (fourth in men and sixth in women) and the second largest cause of cancer mortality in South Korea. The crude incidence rate of liver cancer was 31.9/100,000 (47.5/100,000 in men and 16.2/100,000 in women) and the age-standardized incidence rate was 19.9/100,000 (32.4/100,000 in men and 8.8/100,000 in women) in 2014. The crude incidence rate increased from 1999 to 2011 and thereafter showed a subtle decreasing tendency. The crude prevalence rate was 113.6/100,000 (170.2/100,000 in men and 57.1/100,000 in women) and the age-standardized prevalence rate was 72.6/100,000 (115.7/100,000 in men and 33.7/100,000 in women) in 2014, which increased from 2010 to 2014. Survival from liver cancer has improved over the last two decades. The 5-year relative survival rate was markedly increased from 10.7% in those diagnosed with liver cancer between 1993 and 1995 to 32.8% in those diagnosed between 2010 and 2014. The epidemiology of liver cancer is influenced by that of underlying liver diseases such as viral hepatitis. Substantial progress has been made in the prevention and treatment of viral hepatitis; however, uncontrolled alcoholic liver disease, obesity and diabetes appears to have the potential to emerge as major causes for liver cancer. Depending on the success of the control of risk factors, the epidemiology of liver cancer in Korea may change.
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Development of a New Nomogram Including Neutrophil-to-Lymphocyte Ratio to Predict Survival in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization Young Eun Chon, Hana Park, Hye Kyung Hyun, Yeonjung Ha, Mi Na Kim, Beom Kyung Kim, Joo Ho Lee, Seung Up Kim, Do Young Kim, Sang Hoon Ahn, Seong Gyu Hwang, Kwang-Hyub Han, Kyu Sung Rim, Jun Yong Park Cancers.2019; 11(4): 509. CrossRef
Combination Therapy of Angiotherapy, Radiation Therapy, and Radiofrequency Ablation for Pulmonary Metastasis of Hepatocellular Carcinoma Accompanied by Nontuberculous Mycobacteria Sang Hyun Park, Seul Ki Kim, Ji Hye Kim, Seokgyo Seo, Hyun Pyo Hong, Soo-Youn Ham, Byung Ik Kim Journal of Liver Cancer.2019; 19(1): 79. CrossRef
External validation of the modified PAGE‐B score in Asian chronic hepatitis B patients receiving antiviral therapy Hye Won Lee, Seung Up Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang‐Hyub Han, Beom Kyung Kim Liver International.2019; 39(9): 1624. CrossRef
Updated Treatment of Chronic Hepatitis B Eileen L. Yoon, Hyung Joon Yim The Korean Journal of Medicine.2019; 94(3): 252. CrossRef
KASL clinical practice guidelines for management of chronic hepatitis B
Clinical and Molecular Hepatology.2019; 25(2): 93. CrossRef
A Prospective Evaluation of the Reliability and Utility of Quality of Life Measures in Patients With Hepatocellular Carcinoma Gi-Ae Kim, Ha Il Kim, Seheon Chang, Jihyun An, Danbi Lee, Han Chu Lee, Seungbong Han, Ju Hyun Shim American Journal of Clinical Oncology.2019; 42(7): 555. CrossRef
Comparison of 2 curative treatment options for very early hepatocellular carcinoma Tae Hyung Kim, Jung Mi Chang, Soon Ho Um, Heejung Jee, Yoo Ra Lee, Han Ah Lee, Sun Young Yim, Na Yeon Han, Jae Min Lee, Hyuk Soon Choi, Eun Sun Kim, Young-Dong Yu, Bora Keum, Min Ju Kim, Hyunggin An, Beom Jin Park, Yeon Seok Seo, Dong-Sik Kim, Hyung Joon Medicine.2019; 98(26): e16279. CrossRef
Changes in hepatitis B antibody status after chemotherapy in children with acute lymphoblastic leukemia Young Bae Choi, Na Hee Lee, Eun Sang Yi, Yae‐Jean Kim, Hong Hoe Koo Pediatric Blood & Cancer.2019;[Epub] CrossRef
Prognosis of Untreated Minimally Active Chronic Hepatitis B Patients in Comparison With Virological Responders by Antivirals Hye Won Lee, Seung Up Kim, Jun Yong Park, Oidov Baatarkhuu, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Beom Kyung Kim Clinical and Translational Gastroenterology.2019; 10(6): e00036. CrossRef
The epidemiology of hepatitis B virus infection in Korea Sun Young Yim, Ji Hoon Kim The Korean Journal of Internal Medicine.2019; 34(5): 945. CrossRef
Development and validation of a prognostic model for patients with hepatocellular carcinoma undergoing radiofrequency ablation Chang Gon Kim, Hyun Woong Lee, Hye Jin Choi, Jung Il Lee, Hye Won Lee, Seung Up Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang‐Hyub Han, Han Sang Kim, Kyung Hwan Kim, Seong Jin Choi, Yongun Kim, Kwan Sik Lee, Gyoung Min Kim, Man Deuk Kim, Jong Yoo Cancer Medicine.2019; 8(11): 5023. CrossRef
Effective therapeutic options for elderly patients with hepatocellular carcinoma Jongbeom Shin, Jung Hwan Yu, Young-Joo Jin, Young Ju Suh, Deuck Hwa Kim, Seyoun Byun, Jin-Woo Lee Medicine.2019; 98(30): e16150. CrossRef
Hepatitis B virus DNA levels and overall survival in hepatitis B‐related hepatocellular carcinoma patients with low‐level viremia Tae‐Se Kim, Dong Hyun Sinn, Wonseok Kang, Geum‐Youn Gwak, Yong‐Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik Journal of Gastroenterology and Hepatology.2019; 34(11): 2028. CrossRef
Hepatitis C virus genotype affects survival in patients with hepatocellular carcinoma Hye Kyong Park, Sang Soo Lee, Chang Bin Im, Changjo Im, Ra Ri Cha, Wan Soo Kim, Hyun Chin Cho, Jae Min Lee, Hyun Jin Kim, Tae Hyo Kim, Woon Tae Jung, Ok-Jae Lee BMC Cancer.2019;[Epub] CrossRef
Comparison of Models for Tumor Recurrence after Liver Transplantation for the Patients with Hepatocellular Carcinoma: A Multicenter Long-Term Follow-Up Study Young Chang, Yuri Cho, Jeong-Hoon Lee, Yun Bin Lee, Eun Ju Cho, Su Jong Yu, Dong Hyun Sinn, Bo Hyun Kim, Seoung Hoon Kim, Nam-Joon Yi, Kwang-Woong Lee, Jong Man Kim, Joong-Won Park, Yoon Jun Kim, Jung-Hwan Yoon, Jae-Won Joh, Kyung-Suk Suh Cancers.2019; 11(9): 1295. CrossRef
Combined transarterial chemoembolization and radiotherapy as a first-line treatment for hepatocellular carcinoma with macroscopic vascular invasion: Necessity to subclassify Barcelona Clinic Liver Cancer stage C Yeon Joo Kim, Jinhong Jung, Ji Hyeon Joo, So Yeon Kim, Jin Hyoung Kim, Young-Suk Lim, Han Chu Lee, Jong Hoon Kim, Sang Min Yoon Radiotherapy and Oncology.2019; 141: 95. CrossRef
Prognostic factors in hepatocellular carcinoma patients with bone metastases Sungmin Kim, Youngmin Choi, Dong-Won Kwak, Hyung Sik Lee, Won-Joo Hur, Yang Hyun Baek, Sung Wook Lee Radiation Oncology Journal.2019; 37(3): 207. CrossRef
Conditional Survival Estimates Improve Over Time for Patients with Hepatocellular Carcinoma: An Analysis for Nationwide Korea Cancer Registry Database Jae Seung Lee, In Rae Cho, Hye Won Lee, Mi Young Jeon, Tae Seop Lim, Oidov Baatarkhuu, Do Young Kim, Kwang-Hyub Han, Jun Yong Park Cancer Research and Treatment.2019; 51(4): 1347. CrossRef
Changes in real-life practice for hepatocellular carcinoma patients in the Republic of Korea over a 12-year period: A nationwide random sample study Beom Kyung Kim, Do Young Kim, Kwang-Hyub Han, Jinsil Seong, Jung Weon Lee PLOS ONE.2019; 14(10): e0223678. CrossRef
Potential prognostic factors for solitary hepatocellular carcinoma ≤ 5 cm after transarterial chemoembolization Soon Young Ko, Won Hyeok Choe The Korean Journal of Internal Medicine.2019; 34(6): 1210. CrossRef
Complex interaction networks of cytokines after transarterial chemotherapy in patients with hepatocellular carcinoma Dong Wook Jekarl, Seungok Lee, Jung Hyun Kwon, Soon Woo Nam, Myungshin Kim, Yonggoo Kim, Jeong Won Jang, William B. Coleman PLOS ONE.2019; 14(11): e0224318. CrossRef
Long Term Efficacy of Antiviral Therapy: Mortality and Incidence of Hepatocellular Carcinoma Hyun Woong Lee The Korean Journal of Gastroenterology.2019; 74(5): 251. CrossRef
Updates on Cancer Epidemiology in Korea, 2018 Sun-Seog Kweon Chonnam Medical Journal.2018; 54(2): 90. CrossRef
Prognosis of Spontaneous Bacterial Peritonitis in Hepatocellular Carcinoma Patients Jeong Han Kim, Won Hyeok Choe, So Young Kwon, Byung-chul Yoo Journal of Korean Medical Science.2018;[Epub] CrossRef
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