An aggressive approach leads to improved survival in hepatocellular carcinoma patients with portal vein tumor thrombus

Abstract

PurposeMany physicians express a relatively nihilistic approach to the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Consensus among surgeons regarding the indications for an aggressive approach has not been reached. Current study was aimed to determine whether an aggressive approach, with an extended resection with thrombectomy and adjuvant therapy, would lead to an improved survival for HCC patients with PVTT.MethodsA retrospective review of 116 HCC patients with PVTT admitted from 1996 to 2006 was conducted. Patients were divided into 2 time-period (TP) cohorts, of them, 51 cases in the first 5 years (TP1) and 65 in the last 5 years (TP2).ResultsSurgical operations were performed on 68 patients. Twenty-one surgical resections were performed in TP1 and forty-seven in TP2. The extent of liver resections, as well as the frequency of thrombectomy, was greater in TP2 (P = 0.039). During both time-periods, an aggressive therapy was associated with improved survival (P < 0.02 TP1, P < 0.001 TP2). Overall survival of all patients in TP2 was significantly greater than in TP1 (P < 0.001), with a median survival of 15 months in TP2, whereas in TP1, the survival was only 9 months. The median 1-, 3-year survivals in TP2 (54 and 34%, respectively) were also greater than that in TP1 (31 and 7%, respectively). A multiple logistic regression analysis revealed that radical resection and adjuvant therapy were the independent predictors of overall survival.ConclusionsAn aggressive approach, combining extended liver resection with thrombectomy and adjuvant therapy, leads to an improved survival in the HCC patients with PVTT.

TGF-β-miR-34a-CCL22 Signaling-Induced Treg Cell Recruitment Promotes Venous Metastases of HBV-Positive Hepatocellular Carcinoma

“…The presence of PVTT in patients with HCC is one of the most significant factors for a poor prognosis in developing countries (Lin et al, 2010; Shi et al, 2010). Once PVTT is formed, the tumor cells may spread along the portal vein, leading to extensive bilobar intrahepatic metastasis.…”

Portal Vein Stenting Combined with Iodine-125 Seeds Endovascular Implantation Followed by Transcatheter Arterial Chemoembolization for Treatment of Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus

“…If untreated, the prognosis of patients with HCC and PVTT becomes extremely poor [4]. The median survival of patients with HCC and PVTT is 2.7–4.0 months, whereas survival in patients with HCC but without PVTT is 24.4 months [5–7]. For these patients, there is no effective treatment and the optimal treatment remains controversial [3].…”

Treatment for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: The Emerging Role for Radioembolization Using Yttrium-90

“…As surgical techniques and treatment in general of HCC have improved, survival outcomes have also improved. For successive 5-year periods (1996-2000 vs. 2001-2006), Lin et al [15 ]reported median survivals for patients who had hepatic resection and thrombectomy of 21 and 36 months, respectively (p < 0.001) despite a tendency for patients in the later cohort to have more advanced disease. The location and extent of PVTT also significantly affect the potential survival outcomes following surgery [9].…”

“…The location and extent of PVTT also significantly affect the potential survival outcomes following surgery [9]. Various series have found that patients with PVTT extending to the main trunk of the portal vein or beyond have poorer outcomes after surgery compared to those with PVTT confined to the first- or second-order portal branches (table 1) [9,13,14,15]. …”