Actual long-term survival in HCC patients with portal vein tumor thrombus after liver resection: a nationwide study.

Abstract

Liver resection for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) offers a chance of cure, although survival is often limited. The actual 3-year survival and its associated prognostic factors have not been reported. A nationwide database of HCC patients with PVTT who underwent liver resection with 'curative' intent was analyzed. The clinicopathologic characteristics, the perioperative, and survival outcomes for the actual long-term survivors were compared with the non-long-term survivors (patients who died within 3years of surgery). Univariable and multivariable regression analyses were performed to identify predictive factors associated with long-term survival outcomes. The study included 1590 patients with an actuarial 3-year survival of 16.6%, while the actual 3-year survival rate was 11.7%. There were 171 patients who survived for at least 3years after surgery and 1290 who died within 3years of surgery. Multivariable regression analysis revealed that total bilirubin > 17.1μmol/l, AFP > 400ng/ml, types of hepatectomy, extent of PVTT, intraoperative blood loss > 400ml, tumor diameter > 5cm, tumor encapsulation, R0 resection, liver cirrhosis, adjuvant TACE, postoperative early recurrence (< 1year), and recurrence treatments were independent prognostic factors associated with actual long-term survival. One in nine HCC patients with PVTT reached the long-term survival milestone of 3years after resection. Major hepatectomy, controlling intraoperative blood loss, R0 resection, adjuvant TACE, and 'curative' treatment for initial recurrence should be considered for patients to achieve better long-term survival outcomes.