title: Post-hepatectomy survival in advanced hepatocellular carcinoma with portal vein tumor thrombosis.
abstract: OBJECTIVE
  To analyze hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) using the tumor-node-metastasis (TNM) staging system.
  
  
  METHODS
  We retrospectively analyzed 372 patients with HCC who underwent hepatectomy between 1980 and 2009. We studied the outcomes of HCC patients with PVTT to evaluate the American Joint Committee on Cancer TNM staging system (7(th) edition) for stratifying and predicting the prognosis of a large cohort of HCC patients after hepatectomy in a single-center. Portal vein invasion (vp) 1 was defined as an invasion or tumor thrombus distal to the second branch of the portal vein, vp2 as an invasion or tumor thrombus in the second branch of the portal vein, vp3 as an invasion or tumor thrombus in the first branch of the portal vein, and vp4 as an invasion or tumor thrombus in the portal trunk or extending to a branch on the contralateral side.
  
  
  RESULTS
  The cumulative 5-year overall survival (5yrOS) and 5-year disease-free survival (5yrDFS) rates of the 372 patients were 58.3% and 31.3%, respectively. The 5yrDFS and 5yrOS of vp3-4 patients (n = 10) were 20.0%, and 30.0%, respectively, which was comparable with the corresponding survival rates of vp1-2 patients (P = 0.466 and 0.586, respectively). In the subgroup analysis of patients with macroscopic PVTT (vp2-4), the OS of the patients who underwent preoperative transarterial chemoembolization was comparable to that of patients who did not (P = 0.747). There was a significant difference in the DFS between patients with stage I HCC and those with stage II HCC (5yrDFS 39.2% vs 23.1%, P < 0.001); however, the DFS for stage II was similar to that for stage III (5yrDFS 23.1% vs 13.8%, P = 0.330). In the subgroup analysis of stage II-III HCC (n = 148), only alpha-fetoprotein (AFP) > 100 mg/dL was independently associated with DFS.
  
  
  CONCLUSIONS
  Hepatectomy for vp3-4 HCC results in a survival rate similar to hepatectomy for vp1-2. AFP stratified the stage II-III HCC patients according to prognosis.
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimura
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Shoda
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Konishi
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Murayama
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuriu
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kubota
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nakanishi
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Chouhei
authors.initials: C
authors.lastname: Sakakura
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ochiai
authors.affiliation: Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000150:complications / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016461:Chemoembolization, Therapeutic; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins
keywords: Alpha-fetoprotein; Hepatectomy; Hepatocellular carcinoma; Portal vein tumor thrombosis; Tumor-node-metastasis staging system