title: Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-Sen University, Guangzhou, People's Republic of China.
authors.forename: Zhen-Wei
authors.initials: ZW
authors.lastname: Peng
authors.forename: Rong-Ping
authors.initials: RP
authors.lastname: Guo
authors.forename: Yao-Jun
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Lin
authors.forename: Min-Shan
authors.initials: MS
authors.lastname: Chen
authors.forename: Wan Y
authors.initials: WY
authors.lastname: Lau
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery / Q000628:therapy*; D016022:Case-Control Studies; D016461:Chemoembolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D011169:Portal Vein; D012189:Retrospective Studies; D016019:Survival Analysis; D013927:Thrombosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome