Retrospective Study
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World J Gastroenterol. Dec 7, 2014; 20(45): 17141-17147
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.17141
Appropriate treatment strategies improve survival of hepatocellular carcinoma patients with portal vein tumor thrombus
Jia-Zhou Ye, Yong-Quan Zhang, Hai-Hong Ye, Tao Bai, Liang Ma, Bang-De Xiang, Le-Qun Li
Jia-Zhou Ye, Tao Bai, Liang Ma, Bang-De Xiang, Le-Qun Li, Department of Hepatobiliary and Pancreas Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Yong-Quan Zhang, Hai-Hong Ye, Department of Hepatobiliary and Pancreas Surgery, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Ye JZ and Zhang YQ contributed equally to this work; Ye JZ, Zhang YQ, Ye HH, Bai T, Ma L, Xiang BD and Li LQ designed and performed the research; Ye JZ and Bai T contributed new reagents/analytical tools; Ma L and Xiang BD analyzed the data; and Ye JZ wrote the paper.
Correspondence to: Le-Qun Li, MD, PhD, Professor, Department of Hepatobiliary and Pancreas Surgery, Affiliated Tumor Hospital of Guangxi Medical University, No. 71 Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. lequnlicn@126.com
Telephone: +86-771-3112167 Fax: +86-771-3900863
Received: February 26, 2014
Revised: May 22, 2014
Accepted: July 22, 2014
Published online: December 7, 2014
Abstract

AIM: To evaluate the survival benefits of different treatment strategies for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) and to determine the prognosis factors.

METHODS: Between 2007 and 2009, 338 HCC patients treated for PVTT were retrospectively studied. The patients were divided into 4 groups that underwent different treatments: the conservative treatment group (n = 75), the transarterial chemoembolization (TACE) group (n = 86), the hepatic resection group (n = 90), and the hepatic resection associated with postoperative TACE group (n = 87). Survival rates were determined using the Kaplan-Meier method and differences between the groups were identified through log-rank analysis. Cox’s proportional hazard model was used to identify the risk factors for survival.

RESULTS: The mean survival periods for patients in the conservative treatment, TACE, hepatic resection and hepatic resection associated with postoperative TACE groups were 3.8, 7, 8.2 and 15.1 mo, respectively. Significant differences were observed in the survival rates. For the surgical resection associated with postoperative TACE group, the survival rates after 1, 2 and 3 years were 49%, 37% and 19%, respectively. These results were significantly higher than those of the other groups (P < 0.05). Meanwhile, the 1, 2 and 3 year survival rates for the surgical resection group were 28%, 20% and 15%, whereas those for the TACE group were 17.5%, 0% and 0%, respectively. These values significantly increased after hepatic resection compared with those after TACE (P < 0.05).

CONCLUSION: Surgical resection is the most effective therapeutic strategy for HCC patients with PVTT and results in high hepatic functional reserve. For patients who can tolerate the procedure, postoperative TACE is necessary to prevent recurrence and prolong the survival period.

Keywords: Hepatocellular carcinoma, Portal vein tumor thrombosis, Conservative treatment, Transarterial chemoembolization, Surgical resection, Postoperative transarterial chemoembolization

Core tip: Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is generally considered to be related to or an absolute contraindication for hepatic resection or adjuvant chemotherapeutic methods such as transarterial chemoembolization (TACE). Only conservative and palliative treatments are available. However, many experts have indicated that surgery or TACE prolongs survival and lowers recurrence compared to palliative treatments. Thus, treatments of HCC with PVTT remain controversial. Our study explored appropriate treatment strategies and identified prognostic factors by comparing the survival periods and rates for HCC-PVTT patients with 4 kinds of treatments.