title: Prognostic index for patients with hepatocellular carcinoma combined with tumor thrombosis in the major portal vein.
abstract: BACKGROUND
  This study sought to analyze prognostic factors in patients with hepatocellular carcinoma and tumor thrombosis in the first branch or trunk of the portal vein, and to provide a prognostic index.
  
  
  METHODS
  We performed a retrospective cohort study of 78 consecutive patients with hepatocellular carcinoma and tumor thrombosis in the first branch or trunk of the portal vein who underwent liver resection. Multivariate analysis of survival used the Cox's proportional hazard model.
  
  
  RESULTS
  Median survival time and 3-year survival rate were 0.74 years and 21.7%, respectively. Six factors, ie, absence of ascites, average elimination rate constant of indocyanine green, prothrombin activity, serum albumin level, maximal tumor diameter, and blood loss at operation were univariately related to survival time. By multivariate analysis, absence of ascites (hazard ratio, 2.23; 95% confidence interval, 1.10 to 4.52; p = 0.027), prothrombin activity > or = 75% (hazard ratio, 2.37; confidence interval, 1.30 to 4.32; p = 0.005), and maximal tumor diameter < 5 cm (hazard ratio, 2.37; confidence interval, 1.14 to 4.94; p = 0.021) were independent prognostic factors with similar hazard ratios. We calculated a prognostic index from these factors as follows: (ascites: absent = 0, present = 1) + (prothrombin activity: > or = 75% = 0, < 75% = 1) + (maximal tumor diameter: < 5 cm = 0, > or = 5 cm = 1). This index provided good stratification ability (log-rank, p < 0.001). Median survival times for patients with prognostic index 0, 1, 2, and 3 were 5.6, 1.6, 0.5, and 0.1 years, respectively.
  
  
  CONCLUSIONS
  This prognostic index is a useful for making appropriate treatment strategy decisions for patients with hepatocellular carcinoma and tumor thrombosis in the major portal vein.
authors.affiliation: Department of Gastroenterological Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. ikai@kuhp.kyoto-u.ac.jp
authors.forename: Iwao
authors.initials: I
authors.lastname: Ikai
authors.forename: Etsuro
authors.initials: E
authors.lastname: Hatano
authors.forename: Suguru
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Hideaki
authors.initials: H
authors.lastname: Fujii
authors.forename: Kojiro
authors.initials: K
authors.lastname: Taura
authors.forename: Naoki
authors.initials: N
authors.lastname: Uyama
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Shimahara
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D011169:Portal Vein; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality* / Q000601:surgery