Influence of portal vein tumor thrombus on the clincial effect of FOLFOX4 chemotherapy regimen in treatment of advanced hepatocellular carcinoma

Objective To investigate the clinical effect of oxaliplatin-based chemotherapy regimen in the treatment of advanced hepatocellular carcinoma ( HCC) with portal vein tumor thrombus. Methods A retrospective analysis was performed for the clinical data of 37 patients who were diagnosed with BCLC stage C advanced HCC in Cancer Center of The First Hospital of Jilin University from December 2013 to June 2017 and received more than 2 courses of systemic chemotherapy with FOLFOX4 regimen. The association between clinical outcome and the presence or absence of portal vein tumor thrombus was analyzed. According to the presence or absence of portal vein tumor thrombus, these patients were divided into non-portal vein tumor thrombus group with 20 patients and portal vein tumor thrombus group with17 patients. The chi-square test and the Fisher's exact test were used for comparison of categorical data between groups, and the Mann-Whitney U test was used for comparison of continuous data between groups. The Kaplan-Meier method was used for survival analysis, and the log-rank test was used for comparison of survival curves between groups. After risk factors were screened out by the univariate analysis, the Cox proportional hazards model was used for multivariate analysis, and hazard ratio ( HR) and 95% confidence interval ( CI) were used.Results For all 37 patients, the median progression-free survival was 4 months ( range 1-30 months) and the median overall survival was 9 months ( range 1-34 months) . There were significant differences between the non-portal vein tumor thrombus group and the portal vein tumor thrombus group in objective response rate ( 40. 0% vs 5. 9%, χ2= 4. 1, P = 0. 042) and disease control rate ( 85. 0% vs35. 3%, χ2= 7. 65, P = 0. 006) . There were also significant differences between the two groups in survival time ( P < 0. 001) and 6-, 12-, and 24-month survival rates ( χ2= 16. 76, 8. 70, and 1. 12, P < 0. 001, P = 0. 003, and P < 0. 001) . Common toxic and side effects included leucopenia, neurotoxicity, gastrointestinal reactions, and liver injury, which were relieved after aggressive management. The Cox multivariate analysis showed that tumor burden ( HR = 0. 045, 95% CI: 0. 009-0. 216, P = 0. 001) and portal vein tumor thrombus ( HR =0. 181, 95% CI: 0. 066-0. 497, P < 0. 001) were independent prognostic factors. Conclusion Patients without portal vein tumor thrombus have a significantly better outcome after chemotherapy than those with portal vein tumor thrombus. Portal vein tumor thrombus is an independent negative prognostic factor for advanced HCC after systemic chemotherapy.