Prognostic factors for hepatocellular carcinoma presenting with macroscopic portal vein tumor thrombus.
OBJECTIVE
This study examines the prognostic factors including radiological findings of hepatocellular carcinoma presenting with macroscopic portal vein tumor thrombus.


METHODS
From September 1992 to December 2002, 107 patients with hepatocellular carcinoma and a macroscopic portal vein tumor thrombus were treated at the National Cancer Center Hospital East. Patients' characteristics and diagnostic findings of computed tomography, angiography and computed tomography angiography were analyzed to determine the factors significantly related to the patients' prognosis.


RESULTS
Enhanced portal vein tumor thrombus, main tumor occupying over 40% of the liver and distribution of tumors significantly affected survival. Cavernous transformation, thread and streak signs, arterio-portal shunt, extent of tumor thrombus, grade of venous invasion and tumor size did not affect survival. Clinical findings showed that Child-Pugh classification score over 7, etiology of hepatitis, total bilirubin over 2.2 mg/dL, prothrombin time under 50% and liver transaminases over 100 IU/L were poor prognostic factors. Multivariate analysis showed that AST over 100 IU/L, viral hepatitis and tumor occupying over 40% of the liver strongly affected the prognosis.


CONCLUSIONS
Based on the present results, the most strongly affected prognostic factor was liver function as indicated by high level of transaminases. Various radiological findings did not affect survival. The elevation of transaminases seemed due to destruction of hepatocytes by growing tumor and circulatory disruption due to portal vein tumor thrombus. We concluded that radiological findings of hepatocellular carcinoma presenting with portal vein tumor thrombus indicated only intrahepatic status but not survival. First treatment for hepatocellular carcinoma presenting with portal vein tumor thrombus should be to improve the liver function. Treatment against hepatitis virus might be important and patients with AST over 100 IU/L and a tumor occupying over 40% should not undergo surgical resection.
Sakata
Haruhito
H
Department of Academic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. hsakata@graduate.chiba-u.jp
Konishi
Masaru
M
Ryu
Munemasa
M
Kinoshita
Taira
T
Satake
Mitsuo
M
Moriyama
Noriyuki
N
Ochiai
Takenori
T
D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007564:Japan; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D016522:Oncology Service, Hospital; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods