Hepatocellular Carcinoma With Portal Vein Thrombosis Surgery And Surgical Comparative Analysis Of Prognostic Factors And Efficacy Of TACE

Objective:To evaluate the effect and the clinical prognostic factors in patients with hepatocellular carcinoma with portal vein tumor thrombus (PVTT) after surgery.Method:From January2007to January2012,One hundred and sixty-five patients with hepatocellular carcinoma with PVTT who were underwent hepatectomy and removal of PVTT at the Department of Hepatobiliary Surgery,the Affiliated Tumor Hospital of Guangxi Medical University were enrolled for reviewing clinical prognostic factors. We used Kaplan-Meier method and Cox’s proportional hazards model to analyze Clinical characteristics, prognosis, and patients’survival.Results:Amount the165patients,80(48%) patients died and78(47.2%) patients were diagnosed with tumor recurrence or metastasis. The median survival time was19months. The survival of the patients with PVTT was57%,43.3%,29.4%at1,2,3,years, respectively. Significant prognostic factors of hepatocellular carcinoma with portal vein thrombosis after surgery included Serum AFP before surgery, tumor size, tumor capsule, the type of portal vein thrombosis, satellite lesions and intraoperative blood transfusion by univariate analysis. Independent prognostic factors were Serum AFP before surgery, tumor size, satellite lesions and the type of portal vein thrombosis.Conclusion:Surgery is an effective way of treating hepatocellular carcinoma with portal vein tumor thrombus. The concentration of serum AFP before surgery, tumor size, tumor capsule, portal vein thrombosis type, satellite lesions and intraoperative blood transfusion affect the prognosis of patient with hepatocellular carcinoma with portal vein tumor thrombus after surgery.A patient with hepatocellular carcinoma with portal vein tumor thrombus will suffer a poor prognosis when he get the high serum AFP before surgery, the large tumor size and the lack of tumor capsule. When the time portal vein thrombosis involving the main portal vein, surgery may not be provide a better survival time to the patients with HCC with PVTT. Objective:We aimed to compare the survival benefit of Hepatic Resection with transarterial chemoembolization (TACE) for patients with advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT),furthermore, to reveal which PVTT types benefit from Hepatic Resection or TACE treatment.Method:From January2007to January2012,165patients with hepatocellular carcinoma with PVTT who were treated with hepatectomy and306patients who were treated with TACE at the Affiliated Tumor Hospital of Guangxi Medical University were enrolled for reviewing clinical prognostic factors. Propensity score matching (PSM) was conducted to reduce confounding bias between groups. Then overall survival rate were compared between groups separated by four types of PVTT. Patient survival rate were analyzed by the Kaplan-Meier method and Log-rank method.Results:After matching by the PSM,108patients were both remained in the surgery and TACE group. The survival of the patients in surgery group was 57%,43.3%,29.4%at1,2,3years, respectively, while the TACE group was29.3%,7.6%,4.5%. The overall survival rate in the surgery group is significantly better than the TACE group no matter they matching by the PSM or not. In the subgroup of PVTT type analyze,22patients were both remained in the surgery and TACE group in type I PVTT. The survival of the patients in surgery group was71.6%,59.6%,35.8%at1,2,3years, respectively, while the TACE group was42.3%,16.6%,10.0%.56patients were both remained in the surgery and TACE group in type II PVTT. The survival of the patients in surgery group was53.3%,44.4%,35.8%at1,2,3years, respectively, while the TACE group was3.6%,8.2%,4.7%. The overall survival rate in the surgery group is still better than the TACE group whether they matching by the PSM or not in the type I and type II PVTT. But there shows no difference at the overall survival rate between two groups in type III and type IV PVTT. Both of them the median survival time were shorter than6month.Conclusion:The patients with hepatocellular carcinoma with PVTT underwent surgery have a better overall survival rate than the patients treated by TACE at the same condition. The surgery was showed to provide a better prognosis in the patients with hepatocellular carcinoma with PVTT Ⅰ and Ⅱ. And both of the treatment seems not so efficiency to the patients with hepatocellular carcinoma with PVTT Ⅲ and Ⅳ.