Evaluating the long-term survival benefits of high intensity focused ultrasound ablation for hepatocellular carcinoma with portal vein tumor thrombus: a single center retrospective study

Figures & data

Figure 1. Flowchart of patient selection.

Table 1. Patient characteristics (n = 144).

Characteristics	Results, n (%)
Gender
Male	122 (84.72)
Female	22 (15.28)
Age, years
≤60	104 (72.22)
>60	40 (27.78)
Tumor diameter (mm)
D ≤ 50	27 (18.75)
50<D ≤ 100	57 (39.58)
D > 100	60 (41.67)
Number of tumors
≤3	128 (88.89)
>3	16 (11.11)
PVTT type
I	31 (21.53)
II	72 (50.00)
III	41 (28.47)
HBVsAg, +/− (%)	127 (88.19)/17 (11.81)
Extrahepatic metastasis, yes/no (%)	30 (20.83)/110 (76.39)
Other local treatment
TACE/TAE
Yes/no	109 (75.69)/35 (24.31)
^125I seed implantation
Yes/no	76 (52.78)/68 (47.22)
Systemic therapy
Anti-hepatitis B virus	127 (88.19)
Targeted or PD-1	31 (21.53)

Table 2. Perioperative adverse events of HIFU ablation.

AEs	Results, n (%)	CTCAE
Skin burn	4 (2.78)
I	1 (0.69)	1
II	1 (0.69)	2
III	2 (1.39)	3
Pain	100 (69.44)
Mild	88 (61.11)	1
Moderate	8 (5.56)	2
Severe	4 (2.74)	3
Fever	11 (7.64)
Low	3 (2.08)	1
Moderate	7 (4.86)	2
High	1 (0.69)	3
Peritonitis	2 (1.39)	3
Skin edema	135 (93.75)	1
Intractable hiccups	1 (0.69)	2
Abdominal distention	5 (3.47)	2
Loss of appetite	2 (1.39)	1
Acute kidney injury	1 (0.69)	3
Liver failure	0	4
Perioperative death	0	5
Perioperative bleeding	0	4

Table 3. Overall survival of PVTT and its subgroups.

Variable	Median OS (m)	Mean OS (95%CI) (m)	OS rate (%)
			0.5 y	1 y	2 y	3 y
I	22	27.99 ± 6.77 (14.71–41.26)	89.6	75.6	34.9	17.5
II	13	16.16 ± 1.71 (1.71–12.82)	73.7	50.1	30.4	No data
III	14	19.64 ± 3.15 (3.15–13.48)	82.3	62.2	49.8	No data
I + II	14	19.95 ± 2.92 (14.22–25.69)	78.3	57.5	30.6	6.1
I + II + III	14	20.29 ± 2.75 (14.91–25.67)	79.0	58.6	33.3	5.9

Figure 2. (A) Kaplan–Meier’s curves show OS of PVTT type I, II and III. (B) Kaplan–Meier’s curves show OS of main (type III) and branch (type (I + II)) PVTT.

Table 4. OS and AEs of various treatment options for HCC complicated with PVTT.

Author, year	Treatment strategy	Type	Patients (n)	M-OS (m)	C-OSR (%)				Adverse events, %	Refs.
					0.5 y	1 y	2 y	3 y
Cao et al. [23]	TACE + S	NR	32	11	NR	NR	NR	NR	Hand-foot skin reactions (75), diarrhea (71.9), grade 4–5 AEs (9.3)	[23]
	TACE + A	NR	41	10	NR	NR	NR	NR	Hand-foot skin reactions (73.2), diarrhea (65.9), grade 4–5 AEs (7.2)
Tang et al. [19]	BSC	Total	62	7.8	NR	NR	NR	NR	NR	[19]
		I	21	7.8	NR	NR	NR	NR
		II	28	8	NR	NR	NR	NR
		III	13	7	NR	NR	NR	NR
	TACE	Total	62	11.3	NR	NR	NR	NR	Fever (45.16), liver dysfunction (41.94), abdominal pain (35.48), grade 3/4 AEs (16.13)
		I	28	14.3	NR	NR	NR	NR
		II	23	13	NR	NR	NR	NR
		III	11	4.5	NR	NR	NR	NR
Zhang et al. [24]	DEB-TACE + A	NR	35	18	NR	NR	NR	NR	Hand-foot skin reactions (57.1), nausea/vomiting (62.9), hypertension (45.7)	[24]
	DEB-TACE	NR	35	13	NR	NR	NR	NR	NR
Munire et al. [25]	IMRT + S	NR	30	12	NR	48.6	23.8	NR	Leukopenia and thrombocytopenia (80), hepatic dysfunction (80.7), anorexia (60)	[25]
	IMRT	NR	46	9	NR	34.2	3.5	NR	Leukopenia (67.4), thrombocytopenia (60.9), hepatic dysfunction(58.7), fatigue (52.2)
Ohkoshi-Yamada et al. [26]	CRT + TACE	NR	9	NR	NR	75	NR	75	NR	[26]
Li et al. [20]	TACE-^125Iseed- implantation	NR	27	13.3	NR	NR	NR	NR	Fever (40.7), abdominal pain (33.3), nausea and vomiting (25.9), grade 3 AEs (0)	[20]
	TACE-A	NR	21	10.8	NR	NR	NR	NR	Hypertension (52.4), anorexia (42.4), fever (47.6), grade 3 AEs (52.4)
Li et al. [27]	PVS+^125I + As2O3 +TACE	NR	30	NR	43.7	31.2	NR	NR	Fever (23.3), hemorrhage (6.7), abdominal pain (10.0), grade 3–5 AEs (0)	[27]
Liang et al. [28]	eRFA + TACE	III	12	7.9	NR	NR	NR	NR	Pain and transaminase increases	[28]
Yuan et al. [29]	C + A	Total	63	14.8	87.3	60	NR	NR	Hand-foot skin reaction (52.4), abdominal pain (49.2), hepatitis (46.0), grade 3/4 AEs (28.6)	[29]
		I	32	16	96.9	68.8	NR	NR
		II	20	15.9	95.0	65	NR	NR
		III	11	5.8	45.5	27.3	NR	NR
Ni et al. [30]	TACE-s-MWA	I/II	77	19	NR	NR	NR	NR	Diarrhea (55.8), fatigue (45.5), hand-foot skin (40.3), abdominal pain (19.5)	[30]
Choi et al. [31]	Sorafenib	NR	NR	7.2	NR	NR	NR	NR	Hyperbilirubinemia (34.5), hand-foot syndrome (31.0), AST elevation (27.6)	[31]
	HAIC	NR	NR	14.9	NR	NR	NR	NR	Hyperbilirubinemia (44.8), AST elevation (34.5)
Su et al. [15]	3D-CRT	Total	134	13	NR	54	33	18	NR	[15]
		I	23	NR	NR	65	39	19
		II	49	NR	NR	52	35	11
		III	62	NR	NR	16	3	0
	HR	Total	189	18	NR	62	47	43	Pulmonary infection (11), liver failure (6), grade 3–5 AEs (0)
		I	75	NR	NR	83	53	42
		II	77	NR	NR	55	42	25
		III	37	NR	NR	11	0	0
Jia et al. [32]	Yttrium-90 radioembolization (TARE)	Total	722	9.7	NR	NR	NR	NR	Fatigue, nausea/vomiting, abdominal pain	[32]
		I/II	NR	13.4	NR	NR	NR	NR
		III/IV	NR	6.1	NR	NR	NR	NR
Lee et al. [33]	proton beam	NR	27	13.2	NR	NR	NR	NR	Grade 3–5 AEs 0	[33]

TACE: transcatheter arterial chemoembolization; S: sorafenib; A: apatinib; BSC: best supportive care; DEB-TACE: drug-eluting transcatheter arterial chemoembolization; IMRT: intensity modulated radiation therapy; CRT: conformal radiation therapy; PVS: portal vein stenting; As₂O₃: arsenic trioxide; eRFA: endovascular radiofrequency ablation; C: camrelizumab; MWA: microwave ablation; 3D-CRT: three-dimensional conformal radiation therapy; HAIC: hepatic arterial infusion chemotherapy; HR: hepatic resection; TARE: transarterial arterial radio-embolization; COSR: cumulative overall survival rate; NR: no report.

Figure 3. (A) Kaplan–Meier’s curves show OS of targeted and/or immunotherapy and non-targeted nor immunotherapy. (B) Kaplan–Meier’s curve shows the OS of TACE/TAE and non-TACE/TAE. (C) Boxplots show the tumor size of TACE/TAE and non-TACE/TAE. (D) Kaplan–Meier’s curve shows the OS of ¹²⁵I seed-HIFU and non-¹²⁵I seed-HIFU.

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Data availability statement

All data are available upon request.