# 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.

## Key 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.