Favorable prognostic factors of surgical outcomes in hepatocellular carcinoma patients with portal vein tumor thrombosis

Abstract

Background: Some HCC patients with portal vein tumor thrombosis (PVTT) experience long-term survival after hepatectomy. This study sought to find favorable prognostic factors in patients with HCC PVTT, and additionally to provide a prognostic index from preoperative prognostic factors. Methods: We performed a retrospective cohort study of 225 consecutive patients with HCC and PVTT who underwent hepatectomy. Survival rates of the patients were calculated with regard to clinicopathologic variables. Results: Median survival time and 5-year survival rate were 19.8 months and 31.2%, respectively. In regard to recurrence free survival time, 3 factors, ie, tumor size, number, resection margin were independent significant prognostic factors by multivariate analysis. In regard to overall survival time, 6 factors, ie, total bilirubin, albumin, PIVKA-II, type of hepatectomy, satellite nodules, bile duct invasion, extrahepatic recurrence were independent significant prognostic factors by multivariate analysis. We calculated a prognostic index from significant preoperative prognostic variables as follows: (PIVKA-II: ≤ 400 mAU/mL = 0, > 400 mAU/mL = 1) + (tumor size: ≤ 7.5 cm = 0, > 7.5 cm = 1) + (tumor number: single = 0, multiple = 1). Median survival times for patients with prognostic index, 0 1, 2, and 3 were 54, 21, 20, and 11 months, respectively. Conclusion: Preoperative prognostic index is a useful for making appropriate treatment strategy decision for patients with HCC PVTT. Anatomical hepatectomy has a significant role to prolong overall survival time. At the time of recurrence, logoregional treatment is effective tool to prolong survival time of patients with intrahepatic recurrence.