A South Korean research team has identified an approach to improve survival rates for patients with advanced liver cancer with vascular invasion.
When cancer cells invade blood vessels that supply nutrients to the liver, the likelihood that the cancer will spread throughout the liver or metastasize to other organs increases dramatically. For this reason, liver cancer patients with vascular invasion are known to experience a rapid decline in liver function and to have a poor prognosis.
In general, patients whose liver cancer has invaded blood vessels are classified as having advanced liver cancer corresponding to stage 3 (stage C). For these patients, the most common approach is to combine transarterial chemoembolization or targeted therapy with radiation therapy, and more recently, immunotherapy has also been tried.
However, even with the same treatment, survival time varies widely by patient, ranging from a minimum of 5.8 months to a maximum of 98.4 months. As a result, clinicians also face significant difficulty in choosing the best treatment.
In this context, a research team in the Department of Radiation Oncology at Samsung Medical Center (Professors Hee-cheol Park, Jeong-il Yoo, and Nari Kim) analyzed outcomes by treatment method in 526 patients with liver cancer involving vascular invasion.
The team developed a more precise “risk prediction model” by integrating liver function, tumor size, invasion pattern, and the presence of extrahepatic metastasis. They then confirmed the model’s usefulness in predicting real-world patient outcomes over a median follow-up of 11.6 months.
When patients were classified using the prediction model, the median progression-free survival (the period during which the disease did not worsen) was 11.4 months in the ultra-low-risk group and 1.9 months in the high-risk group, showing a clear difference. Overall survival also contrasted sharply, at 47.3 months in the ultra-low-risk group versus 6.6 months in the high-risk group.
In particular, the optimal treatment approach differed depending on patients’ risk level. According to the team, for the relatively lower-risk ultra-low-risk and low-risk groups, the best outcomes were achieved by combining the conventional approach of transarterial chemoembolization with radiation therapy.
In contrast, immunotherapy was more effective in the intermediate- and high-risk groups. When immunotherapy was combined with radiation therapy, the risk of disease progression decreased by 43% and the risk of death decreased by 24% compared with the conventional approach. When immunotherapy was used alone, the risk of death decreased by as much as 62% compared with the conventional approach.
The team explained that radiation therapy not only destroys cancer cells but also activates the immune system, producing a kind of “vaccine effect,” which in turn enhanced the effectiveness of immunotherapy.
Professor Jeong-il Yoo emphasized, “Patients with liver cancer involving vascular invasion have a very wide range of clinical characteristics,” adding, “Rather than deciding treatment based solely on stage, predicting risk and identifying the treatment combination that offers the greatest benefit for each individual patient is the fastest way to improve survival.”
The findings of this study were published in the latest issue of the international journal 《Radiotherapy and Oncology》.
