title: Comprehensive treatments for hepatocellular carcinoma with tumor thrombus in major portal vein.
abstract: OBJECTIVE
  To evaluate the efficacy of transcatheter arterial chemoembolisation (TACE) compared with surgical intervention and sorafenib for treatment of hepatocellular carcinoma (HCC) in patients with tumor thrombus extending to the main portal vein.
  
  
  METHODS
  From 2009 to 2013, a total of 418 HCC patients with tumor thrombus extending to the main portal vein were enrolled in this study and divided into four groups. These groups underwent different treatments as follows: TACE (n = 307), surgical intervention (n = 54), sorafenib (n = 15) and palliative treatment (n = 42). Overall survival rates were determined by 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 TACE, surgical intervention, sorafenib and palliative treatment groups were 10.39, 4.13, 5.54 and 2.82 mo, respectively. For the TACE group, the 3-, 6-, 12- and 24-mo survival rates were 94.1%, 85.9%, 51.5% and 0.0%, respectively. The corresponding rates were 60.3%, 22.2%, 0.0% and 0.0% for the surgical intervention group and 50.9%, 29.5%, 0.0% and 0.0% for the sorafenib group. Evidently, the results in the TACE group were significantly higher than those in the other groups (P < 0.0001). Furthermore, no significant difference among survival rates was observed between TACE with/without sorafenib (10.22 mo vs 10.52 mo, P = 0.615). No significant difference in survival rates was also found among the surgical intervention, sorafenib and palliative treatment groups (P > 0.05). These values significantly increased after TACE with/without sorafenib compared with other treatments (P < 0.05).
  
  
  CONCLUSIONS
  For HCC patients with tumor thrombus extending to the main portal vein, TACE can yield a higher survival rate than surgical intervention or sorafenib treatment.
authors.affiliation: Hai-Hong Ye, Department of Hepatobiliary Surgery, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China.
authors.forename: Hai-Hong
authors.initials: HH
authors.lastname: Ye
authors.affiliation: Hai-Hong Ye, Department of Hepatobiliary Surgery, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China.
authors.forename: Jia-Zhou
authors.initials: JZ
authors.lastname: Ye
authors.affiliation: Hai-Hong Ye, Department of Hepatobiliary Surgery, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China.
authors.forename: Zhi-Bo
authors.initials: ZB
authors.lastname: Xie
authors.affiliation: Hai-Hong Ye, Department of Hepatobiliary Surgery, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China.
authors.forename: Yu-Chong
authors.initials: YC
authors.lastname: Peng
authors.affiliation: Hai-Hong Ye, Department of Hepatobiliary Surgery, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Hai-Hong Ye, Department of Hepatobiliary Surgery, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Ma
authors.affiliation: Hai-Hong Ye, Department of Hepatobiliary Surgery, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Bai
authors.affiliation: Hai-Hong Ye, Department of Hepatobiliary Surgery, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China.
authors.forename: Jun-Ze
authors.initials: JZ
authors.lastname: Chen
authors.affiliation: Hai-Hong Ye, Department of Hepatobiliary Surgery, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Lu
authors.affiliation: Hai-Hong Ye, Department of Hepatobiliary Surgery, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China.
authors.forename: Hong-Gui
authors.initials: HG
authors.lastname: Qin
authors.affiliation: Hai-Hong Ye, Department of Hepatobiliary Surgery, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China.
authors.forename: Bang-De
authors.initials: BD
authors.lastname: Xiang
authors.affiliation: Hai-Hong Ye, Department of Hepatobiliary Surgery, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China.
authors.forename: Le-Qun
authors.initials: LQ
authors.lastname: Li
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000150:complications / 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 / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016017:Odds Ratio; D010671:Phenylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D011169:Portal Vein / Q000473:pathology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D000077157:Sorafenib; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib
keywords: Hepatocellular carcinoma; Portal vein; Sorafenib; Surgery; Transcatheter arterial chemoembolisation; Tumor thrombus