Clinical Comparison Between Curative and Non-Curative Treatment for Hepatocellular Carcinoma with Hepatic Vein Invasion: A Nationwide Cohort Study

TL;DR

This study finds that curative treatments for advanced liver cancer with vein invasion can improve survival in patients with good liver function.

Contribution

Demonstrates curative treatments can benefit advanced liver cancer patients with vein invasion, challenging standard palliative care.

Findings

Curative treatments improved overall and cancer-specific survival compared to non-curative approaches.

Tumor burden was similar between groups, but survival outcomes differed significantly.

Preserved liver function and good performance status are key factors for curative treatment success.

Abstract

Hepatocellular carcinoma (HCC) with hepatic vein invasion (HVI) is typically treated with palliative approaches due to its advanced stage. However, this study shows that curative-intent treatments such as surgical resection or local ablation can significantly improve long-term survival in selected patients. Using data from a large Korean national registry, we compared outcomes between patients receiving curative versus non-curative treatment after adjusting for key clinical factors. Despite similar tumor burden, those in the curative group showed markedly better overall and cancer-specific survival. These findings suggest that curative approaches may offer a meaningful survival benefit for HCC even in the presence of HVI in patients with preserved liver function and good performance status.

Background: Hepatocellular carcinoma (HCC) with hepatic vein invasion (HVI) is classified as advanced stage and palliative management is the primary treatment option. This study compared the long-term outcomes of curative and non-curative treatments in patients of HCC with HVI. Methods: Data were obtained from a retrospective multicenter cohort of the Korean Primary Liver Cancer Registry. We reviewed 18,315 patients newly diagnosed with HCC between 2008 and 2019. After propensity score matching based on the albumin-bilirubin (ALBI) score; tumor number, and tumor size, clinical outcomes were compared between the curative group (n = 42, 29.0%) undergoing surgical resection or local ablation and the non-curative group (n = 103, 71.0%) receiving other treatments. Results: Tumor burdens such as tumor number, maximum tumor size, levels of alpha-fetoprotein (AFP), and protein induced by absence of vitamin K or antagonist-II did not differ significantly between the groups (p = 0.672, p = 0.143, p = 0.153 and p = 0.651, respectively). In long-term outcomes, the overall survival (OS) and cancer-specific survival (CSS) were significantly better in the curative group compared to the non-curative group (p < 0.001, both). Multivariate analysis indicated that non-curative treatment, ALBI grade ≥ 2, and AFP ≥ 400 ng/mL were common risk factors for OS and CSS. Conclusions: Curative-intent treatment has the potential to significantly enhance long-term outcomes in selected patients of HCC with HVI who preserved liver function and performance status.

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