Prognosis Of Patients With Hepatocellular Carcinoma Combined With Tumor Thrombosis In The Major Portal Vein

Background:Hepatocellular carcinoma (HCC) is the second cause of death due to malignancy in the world, following lung cancer. Unfortunately, only a small part of HCCs are amenable to "curative" surgical resection at the time of diagnosis. Lots of the HCCs are in the advanced or end stage of tumor, there is a high rate combining with vascular and bile duct tumor thrombosis. Portal vein tumor thrombosis is common, the incidence rate is 10-44%. When tumor thrombus extends to involve the main portal vein, prognosis is extremely poor because of extensive intrahepatic metastases; deterioration of liver function, intractable ascites and esophageal variceal bleeding. If left untreated, a median survival of 2.7-4.0 months was reported. According to the BCLC staging classification, HCC with PVTT belongs to stage C, the recommended treatment is new agents treatment. Lots of patients accepted palliative treatments and died in months; However, with the development of department of hepatObiliary surgery, the treatments for HCC with PVTT become diversified, including alblation, TACE, hepatectomy and multidisciplinary therapy, which promote the prognosis of HCC with PVTT.Methods:We performed a retrospective study of 69 consecutive patients with hepatocellular carcinoma and tumor thrombosis in the first branch or trunk of the portal vein in the First Affiliated Hospital of Zhejiang University from January 2011 to December 2014.We divided those patients into 4 groups:(1)the conservative therapy group (Group A; n=9);(2) the transarterial chemoembolization group (Group B; n=16); (3) the liver resection group (Group C; n=20);(4) the multidisciplinary therapy group (Group D; n=24). Multivariate analysis of survival used the Cox’s proportional hazard model.Results:No significant differences were found among the four groups’ baseline clinical data which included the tumor count, tumor size, HBV DNA, and the type of PVTT (P>0.05). Group A’s median survival time and overall cumulative survival rates at 0.5,1,2 and 3 years of were 3.1 months,11.1%,0.0%.0.0%,0.0%; Group B’s median survival time and overall cumulative survival rates at 0.5,1,2 and 3 years of were 6.1 months,56.3% ,12.5%.0.0%,0.0%; Group C’s median survival time and overall cumulative survival rates at 0.5,1,2 and 3 years of were 8.5 months,70.0%,40.0%. 10.0%,0.0%; Group D’s median survival time and overall cumulative survival rates at 0.5,1,2 and 3 years of were 12.9 months,83.3%,62.5%.24.3%,16.2%; Applying the Cox’s multivariate proportional hazard model indicated that significant adverse prognostic indicators included surgical resection, TACE, the tumor in both lobes, tumor size>10 cm and the type of PVTT.Conclusion:The prognosis of HCC with major potal vein tumor thrombosis was poor; Surgical treatment may promote the overall survive of HCC patients with major portal vein tumor thrombosis. Postoperative TACE may improve the survival rate.