title: Hepatocellular carcinoma invading portal venous system in cirrhosis: long-term results of percutaneous radiofrequency ablation of both the nodule and portal vein tumor thrombus. A case control study.
abstract: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death. Portal vein tumor thrombus (PVTT) is one of the most dreadful complications of HCC and is associated with a median survival time of 2.7-4.0 months. The optimal treatment for HCC with PVTT has not yet been established. The aim of the present study was to report long-term results of percutaneous radiofrequency (RF) ablation of both HCC single nodule (up to 5 cm in diameter) and neoplastic main portal vein thrombus, compared to no-treatment.
  
  
  METHODS
  From January 2005 to January 2010, out of 2,847 consecutive cirrhosis patients, 672 had HCC and main portal vein tumor thrombus (MPVTT); among these, 57 had a single HCC with MPVTT. Thirty-five patients with 35 single HCC nodules (ranging from 3.7 to 5 cm in diameter) underwent percutaneous RF ablation of both the nodule and the thrombus (cases); 22 patients refused RF ablation or any other treatment (controls).
  
  
  RESULTS
  A complete necrosis of HCC nodules associated with re-canalization of main portal trunk (MPT) and its branches were observed in 26 patients (success rate=74%). The 1-, 3- and 5-year cumulative survival rates of patients were 63%, 30% and 20%, respectively. The 12-month cumulative survival rate of controls was 0% (p<0.0001). The difference was statistically significant (p<0.001; harzard ratio (HR)=2.88; 95% confidence interval (CI)=1.57-5.39). The 3- and 5-year cumulative disease-free survival rates of the patients were 35% and 22%, respectively. No deaths occurred.
  
  
  CONCLUSIONS
  RF ablation of HCC and the accompanying MPVTT significantly prolongs long-term survival compared to no-treatment. The procedure is safe and should be considered as a new and effective tool in the treatment of advanced HCC.
authors.affiliation: Interventional Ultrasound Unit, Ruesch Clinical Institute, Department of Surgery, Naples, Italy Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy agiorgio28@gmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Giorgio
authors.affiliation: Department of Virology, Royal Free Hospital, London, U.K.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Calisti
authors.affiliation: Interventional Ultrasound Unit, Ruesch Clinical Institute, Department of Surgery, Naples, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Montesarchio
authors.affiliation: Interventional Ultrasound Unit, Ruesch Clinical Institute, Department of Surgery, Naples, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Scognamiglio
authors.affiliation: Radiotherapy and Oncology Department, Campus Biomedico University, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Matteucci
authors.affiliation: Hepatology and Intervenvetional US Unit, Gragnano Hospital, Gragnano, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Coppola
authors.affiliation: Hepatology and Intervenvetional US Unit, Gragnano Hospital, Gragnano, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Scarano
authors.affiliation: Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Amendola
authors.affiliation: Hepatometabolic Disease Unit, Bambino Gesù Children Hospital, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Giorgio
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D009367:Neoplasm Staging; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*
keywords: Hepatocellular carcinoma; neoplastic portal vein tumor thrombus; percutaneous radiofrequency ablation