Surgical Strategy for Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus Based on Prognostic Factors

Kondo, Kazuhiro; Chijiiwa, Kazuo; Kai, Masahiro; Otani, Kazuhiro; Nagaike, Koki; Ohuchida, Jiro; Hiyoshi, Masahide; Nagano, Motoaki

doi:10.1007/s11605-009-0854-2

Cited by 63 publications

(66 citation statements)

References 16 publications

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“…A median survival ranging from 8.9 to 33 months was reported for HCC with PVTT with surgical treatment. [13][14][15][16][17][18][19] Although these results seems to be superior to TACE, patients who received HR were highly selected. We, therefore, conducted this casematch-control study comparing HR with TACE in the treatment of HCC with PVTT.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, after HR, there was one postoperative in-hospital death caused by postoperative liver failure (0.5%), and the major complication rate was 4.0% (8 of 201), our results were similar to the studies reported previously. [13][14][15][16][17][18][19][20][21][22] Therefore, HR is still a safe treatment for HCC with PVTT.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12] To improve on the results of treatment of HCC with PVTT, attempts have been made to perform HR for these patients. [13][14][15][16][17][18][19][20][21][22] HCC with PVTT remains a contraindication to liver transplantation because of the high rate of tumor recurrence, and because of the severe shortage of donor organs. HR remains the only therapeutic option that may still offer a chance of cure.…”

Section: Introductionmentioning

confidence: 99%

“…More HCC with PVTT, which previously were considered as unresectable, have become resectable. [13][14][15][16][17][18][19][20][21][22] Recent studies have even shown favorable long-term survival outcomes of HR in well-selected cases of HCC with PVTT. 21,22 However, the survival outcomes of patients with HCC with PVTT treated with HR or with TACE have not been properly compared.…”

Section: Introductionmentioning

confidence: 99%

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Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus

Peng

Guo

Zhang

et al. 2012

Cancer

144

163

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BACKGROUND:The long‐term survival outcomes of hepatic resection (HR) compared with transcatheter arterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) are unclear.MATERIALS AND METHODS:Between December 2002 and December 2007, 201 consecutive patients diagnosed with resectable HCC with PVTT received HR as an initial treatment in our center. These patients were compared with 402 case‐matched controls selected from a pool of 1798 patients (with a 1:2 ratio) who received TACE as an initial treatment during the study period. PVTT was classified to 4 types: PVTT involving the segmental branches of the portal vein or above (type I), PVTT extending to involve the right/left portal vein (type II), the main portal vein (type III), or the superior mesenteric vein (type IV).RESULTS:The 1‐, 3‐, and 5‐year overall survivals for the HR and TACE groups were 42.0%, 14.1%, and 11.1% and 37.8%, 7.3%, and 0.5%, respectively (P < .001). On subgroup analyses, the overall survivals for the HR group were better than the TACE group for type I PVTT, type II PVTT, single tumor, and tumor size >5 cm (P < .001, P = .002, P < .001, P < .001, respectively), but not for type III PVTT, type IV PVTT, multiple tumors, and tumor size <5 cm (P = .541, P = .371, P = .264, P = .338, P = .125, respectively). Multivariate analysis showed the type of PVTT and initial treatment allocation were significant prognostic factors for overall survival.CONCLUSIONS:Compared with TACE, HR provided survival benefits for patients with resectable HCC with PVTT, especially for those with a type I PVTT or a type II PVTT. Cancer 2012. © 2012 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus

Peng

Guo

Zhang

et al. 2012

Cancer

144

163

View full text Add to dashboard Cite

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“…Portal vein involvement, lymph node metastasis and extrahepatic metastasis had been found to be poor prognostic variables in multiple studies [22][23][24][25][26]. Portal venous thrombosis can lead to complications of portal hypertension.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of unresectable hepatocellular carcinoma: Comparison of seven staging systems (TNM, Okuda, BCLC, CLIP, CUPI, JIS, CIS) in a Chinese cohort.

Zhang

Shu

et al. 2016

JCO

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Effectiveness of multimodality treatment for hepatocellular carcinoma patients with portal vein thrombosis: A real world experience

Kuo

Cheng

et al. 2021

Adv in Digestive Medicine

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Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths worldwide. Portal vein thrombosis (PVT) can induce intrahepatic metastasis, deteriorate liver reserves, and worsen the prognosis of HCC.Although systemic therapy is currently standard treatment, multimodality treatment is used in clinical practices. HCC patients with PVT registered in the Cancer center of Taipei Tzu-Chi Hospital from January 2010 to January 2016 were retrospectively enrolled. PVT was categorized according to Japanese Vp classification. A total of 101 HCC patients with PVT were included for final analysis. The 1-, 3-, or 5-year survival rate was 33.7%, 11.9%, or 5%, respectively. The median overall survival was significantly better in HCC patients with branch PVT (BPV) than those with main PVT (MPV) (7 vs 4.8 months, P = .009) and in those receiving surgical resection than those without (12.8 vs 5.6 months, P < .001). Using Cox regression analysis after adjustment with confounding factors, surgical resection was the only favorable predictor of a survival rate (hazard ratio 0.14; 95% confidence interval 0.05-0.38) in HCC patients with PVT. In conclusion, the overall survival was better in HCC patients with branch PVT and those receiving surgical resection. Surgical resection is the only favorable predictor of overall survival for HCC patients with PVT rather than other multimodality treatment including sorafenib, suggesting surgical resection is not contra-indicated for HCC patients with PVT especially branch type PVT.

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Surgical Strategy for Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus Based on Prognostic Factors

Abstract: Hepatic resection as a first-choice treatment should be carefully selected in patients with Vp4 unless emergent removal of the PVTT is required.

Cited by 63 publications

References 16 publications

Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus

Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus

Prognosis of unresectable hepatocellular carcinoma: Comparison of seven staging systems (TNM, Okuda, BCLC, CLIP, CUPI, JIS, CIS) in a Chinese cohort.

Effectiveness of multimodality treatment for hepatocellular carcinoma patients with portal vein thrombosis: A real world experience

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