Efficacy of different treatment strategies for hepatocellular carcinoma with portal vein tumor thrombosis.
OBJECTIVE
To evaluate the efficacy of different treatment strategies for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) and investigate factors influencing prognosis.


METHODS
One hundred and seventy-nine HCC patients with macroscopic PVTT were enrolled in this study. They were divided into four groups and underwent different treatments: conservative treatment group (n = 18), chemotherapy group (n = 53), surgical resection group (n = 24) and surgical resection with postoperative chemotherapy group (n = 84). Survival rates of the patients were analyzed by the Kaplan-Meier method. A log-rank analysis was performed to identify group differences. Cox's proportional hazards model was used to analyze variables associated with survival.


RESULTS
The mean survival periods of the patients in four groups were 3.6, 7.3, 10.1, and 15.1 mo respectively. There were significant differences in the survival rates among the groups. The survival rates at 0.5-, 1-, 2-, and 3-year in surgical resection with postoperative chemotherapy group were 55.8%, 39.3%, 30.4%, and 15.6% respectively, which were significantly higher than those of other groups (P<0.001). Multivariate analysis revealed that the strategy of treatment (P<0.001) and the number of chemotherapy cycles (P = 0.012) were independent survival predictors for patients with HCC and PVTT.


CONCLUSIONS
Surgical resection of HCC and PVTT combined with postoperative chemotherapy or chemoembolization is the most effective therapeutic strategy for the patients who can tolerate operation. Multiple chemotherapeutic courses should be given postoperatively to the patients with good hepatic function reserve.
Fan
Jia
J
Liver Cancer Institute, Zhongshan Hospital, Fudan University, 136 Yixueyuan Road, Shanghai 200032, China. jiafan99@yahoo.com
Zhou
Jian
J
Wu
Zhi-Quan
ZQ
Qiu
Shuang-Jian
SJ
Wang
Xiao-Ying
XY
Shi
Ying-Hong
YH
Tang
Zhao-You
ZY
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011379:Prognosis; D016016:Proportional Hazards Models; D013927:Thrombosis / Q000209:etiology* / Q000401:mortality
D000970:Antineoplastic Agents