title: Appropriate treatment strategies improve survival of hepatocellular carcinoma patients with portal vein tumor thrombus.
abstract: OBJECTIVE
  To evaluate the survival benefits of different treatment strategies for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) and to determine the prognosis factors.
  
  
  METHODS
  Between 2007 and 2009, 338 HCC patients treated for PVTT were retrospectively studied. The patients were divided into 4 groups that underwent different treatments: the conservative treatment group (n = 75), the transarterial chemoembolization (TACE) group (n = 86), the hepatic resection group (n = 90), and the hepatic resection associated with postoperative TACE group (n = 87). Survival rates were determined using the Kaplan-Meier method and differences between the groups were identified through log-rank analysis. Cox's proportional hazard model was used to identify the risk factors for survival.
  
  
  RESULTS
  The mean survival periods for patients in the conservative treatment, TACE, hepatic resection and hepatic resection associated with postoperative TACE groups were 3.8, 7, 8.2 and 15.1 mo, respectively. Significant differences were observed in the survival rates. For the surgical resection associated with postoperative TACE group, the survival rates after 1, 2 and 3 years were 49%, 37% and 19%, respectively. These results were significantly higher than those of the other groups (P < 0.05). Meanwhile, the 1, 2 and 3 year survival rates for the surgical resection group were 28%, 20% and 15%, whereas those for the TACE group were 17.5%, 0% and 0%, respectively. These values significantly increased after hepatic resection compared with those after TACE (P < 0.05).
  
  
  CONCLUSIONS
  Surgical resection is the most effective therapeutic strategy for HCC patients with PVTT and results in high hepatic functional reserve. For patients who can tolerate the procedure, postoperative TACE is necessary to prevent recurrence and prolong the survival period.
authors.affiliation: Jia-Zhou Ye, Tao Bai, Liang Ma, Bang-De Xiang, Le-Qun Li, Department of Hepatobiliary and Pancreas Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
authors.forename: Jia-Zhou
authors.initials: JZ
authors.lastname: Ye
authors.affiliation: Jia-Zhou Ye, Tao Bai, Liang Ma, Bang-De Xiang, Le-Qun Li, Department of Hepatobiliary and Pancreas Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
authors.forename: Yong-Quan
authors.initials: YQ
authors.lastname: Zhang
authors.affiliation: Jia-Zhou Ye, Tao Bai, Liang Ma, Bang-De Xiang, Le-Qun Li, Department of Hepatobiliary and Pancreas Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
authors.forename: Hai-Hong
authors.initials: HH
authors.lastname: Ye
authors.affiliation: Jia-Zhou Ye, Tao Bai, Liang Ma, Bang-De Xiang, Le-Qun Li, Department of Hepatobiliary and Pancreas Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Bai
authors.affiliation: Jia-Zhou Ye, Tao Bai, Liang Ma, Bang-De Xiang, Le-Qun Li, Department of Hepatobiliary and Pancreas Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Ma
authors.affiliation: Jia-Zhou Ye, Tao Bai, Liang Ma, Bang-De Xiang, Le-Qun Li, Department of Hepatobiliary and Pancreas Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
authors.forename: Bang-De
authors.initials: BD
authors.lastname: Xiang
authors.affiliation: Jia-Zhou Ye, Tao Bai, Liang Ma, Bang-De Xiang, Le-Qun Li, Department of Hepatobiliary and Pancreas Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
authors.forename: Le-Qun
authors.initials: LQ
authors.lastname: Li
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011169:Portal Vein / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*
keywords: Conservative treatment; Hepatocellular carcinoma; Portal vein tumor thrombosis; Postoperative transarterial chemoembolization; Surgical resection; Transarterial chemoembolization