Liver regeneration after portal and hepatic vein embolization improves overall survival compared with portal vein embolization alone: mid-term survival analysis of the multicentre DRAGON 0 cohort
Authors: Korenblik Remon , Heil Jan , Smits Jens , James Sinead , Olij Bram , Bechstein Wolf O , Bemelmans Marc H A , Binkert Christoph A , Breitenstein Stefan , Williams Michael , Detry Olivier , Dewulf Maxime J L , Dili Alexandra , Grochola Lukasz F , Grote Jon , Heise Daniel , Kalil Jennifer A , Metrakos Peter , Neumann Ulf P , Pappas Sam G , Pennetta Francesca , Schnitzbauer Andreas A , Tasse Jordan C , Winkens Bjorn , Olde Damink Steven W M , van der Leij Christiaan , Schadde Erik , van Dam Ronald M ,   DRAGON trials collaborative, Aldrighetti L , van Baardewijk L , Barbier L , Binkert C , Björnsson B , E Cugat Andorrà , Arslan B , Baclija I , Bemelmans M H A , Bent C , de Boer M T , Bokkers R P H , de Boo D , Breen D , Breitenstein S , Bruners P , Cappelli A , Carling U , i Robert M Casellas , Chan B , De Cobelli F , Cha C , Choi J , Crawford M , Croagh D , van Dam R M , Deprez F , Detry O , Dewulf M , Díaz-Nieto R , Dili A , Erdmann J I , Font J Codina , Davis R , Delle M , Fernando R , Fisher O , Fouraschen S , Fretland Å A , Fundora Y , Gelabert A , Gerard L , Gobardhan P , Gómez F , Guiliante F , Gruenberger T , Grochola L F , Grünhagen D , Guitart Giménez J , Hagendoorn J , Heil J , Heise D , Herrero E , Hess G , Hilal M Abu , Hoffmann M , Iezzi R , Imani F , Inmutto N , James S , Borobia F Garcia , Jovine E , Kalil J , Kingham P , Kollmar O , Kleeff J , van der Leij C , Lopez-Ben S , Macdonald A , Meijerink M , Korenblik R , Lapisatepun W , Leclercq W , Lindsay R , Lucidi V , Madoff D C , Martel G , Mehrzad H , Menon K , Metrakos P , Modi S , Montanari N , Moragues J Sampere , Navinés López J , Neumann U P , Nguyen J , Peddu P , Primrose J , Damink S W M Olde , Qu X , Raptis D A , Ratti F , Ryan S , Ridouani F , Rinkes I H M Borel , Rogan C , Ronellenfitsch U , Serenari M , Salik A , Sallemi C , Sandström P , Martin E Santos , Sarría L , Schadde E , Serrablo A , Settmacher U , Smits J , Smits M L J , Snitzbauer A , Soonawalla Z , Sparrelid E , Spuentrup E , Stavrou G , Sutcliffe R , Tancredi I , Tasse J C , Teichgräber U , Udupa V , Valenti D A , Vass D , Vogl T , Wang X , White S , De Wispelaere J F , Wohlgemuth W , YU D , Zijlstra I J A J 
Published: April 2024

Abstract

Background
The purpose of this study was to compare 3-year overall survival after simultaneous portal (PVE) and hepatic vein (HVE) embolization versus PVE alone in patients undergoing liver resection for primary and secondary cancers of the liver.

Methods
In this multicentre retrospective study, all DRAGON 0 centres provided 3-year follow-up data for all patients who had PVE/HVE or PVE, and were included in DRAGON 0 between 2016 and 2019. Kaplan–Meier analysis was undertaken to assess 3-year overall and recurrence/progression-free survival. Factors affecting survival were evaluated using univariable and multivariable Cox regression analyses.

Results
In total, 199 patients were included from 7 centres, of whom 39 underwent PVE/HVE and 160 PVE alone. Groups differed in median age (P = 0.008). As reported previously, PVE/HVE resulted in a significantly higher resection rate than PVE alone (92 versus 68%; P = 0.007). Three-year overall survival was significantly higher in the PVE/HVE group (median survival not reached after 36 months versus 20 months after PVE; P = 0.004). Univariable and multivariable analyses identified PVE/HVE as an independent predictor of survival (univariable HR 0.46, 95% c.i. 0.27 to 0.76; P = 0.003).

Conclusion
Overall survival after PVE/HVE is substantially longer than that after PVE alone in patients with primary and secondary liver tumours.