title: Optimal surgical strategy for hepatocellular carcinoma with portal vein tumor thrombus: a propensity score analysis.
abstract: OBJECTIVE
  The optimal surgical resection method for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) that maximizes both safety and long-term outcome has not yet been determined. The aim of this study was to compare the clinical outcomes following peeling off versus en bloc resection for PVTT.
  
  
  METHODS
  From 2005 to 2012, 252 patients with HCC and type I/II PVTT who underwent hepatic resection were divided into two groups according to whether they received en bloc resection (n = 113) or peeling off resection (n = 139). The clinical outcomes were compared before and after propensity score matching.
  
  
  RESULTS
  The propensity model matched 113 patients with en bloc resection for further analyses. After matching, overall survival (OS) and disease-free survival (DFS) rates were significantly increased in the en bloc group compared with the peeling off group (p = 0.011 and p = 0.015). A multivariate analysis indicated that en bloc resection independently improved both OS and DFS (HR = 1.471, 95% CI: 1.071-2.018, p = 0.017 and HR = 1.415, 95% CI: 1.068-1.874, P=0.016). The adverse events were not significantly different between the two groups. However, the peeling off group showed a significantly increased recurrence rate of vascular invasion compared with the en bloc group (23.9% vs. 9.7%, p = 0.005). Similar results were also demonstrated prior to the matched analysis.
  
  
  CONCLUSIONS
  An en bloc resection is safe and confers a survival advantage compared with a peeling off resection in HCC patients with PVTT; thus, en bloc resection should be recommended as a standard treatment for these patients when possible.
authors.affiliation: Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.|State Key Laboratory of Oncology in South China, Guangzhou, P.R. China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China.
authors.forename: Yong-Fa
authors.initials: YF
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.|State Key Laboratory of Oncology in South China, Guangzhou, P.R. China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Le
authors.affiliation: Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.|State Key Laboratory of Oncology in South China, Guangzhou, P.R. China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wei
authors.affiliation: Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China.|Department of Ultrasonography of Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
authors.forename: Ru-Hai
authors.initials: RH
authors.lastname: Zou
authors.affiliation: Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.|State Key Laboratory of Oncology in South China, Guangzhou, P.R. China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China.
authors.forename: Jia-Hong
authors.initials: JH
authors.lastname: Wang
authors.affiliation: Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.|State Key Laboratory of Oncology in South China, Guangzhou, P.R. China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China.
authors.forename: Han-Yue
authors.initials: HY
authors.lastname: OuYang
authors.affiliation: Department of General surgery, Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University, Shenzhen, P.R. China.
authors.forename: Cheng-Zuo
authors.initials: CZ
authors.lastname: Xiao
authors.affiliation: Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.|State Key Laboratory of Oncology in South China, Guangzhou, P.R. China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China.
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Zhong
authors.affiliation: Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.|State Key Laboratory of Oncology in South China, Guangzhou, P.R. China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China.
authors.forename: Ming
authors.initials: M
authors.lastname: Shi
authors.affiliation: Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.|State Key Laboratory of Oncology in South China, Guangzhou, P.R. China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China.
authors.forename: Rong-Ping
authors.initials: RP
authors.lastname: Guo
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011169:Portal Vein / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D057216:Propensity Score; D011446:Prospective Studies; D012189:Retrospective Studies; D013927:Thrombosis / Q000473:pathology*; D016896:Treatment Outcome
keywords: en bloc resection; hepatic resection; hepatocellular carcinoma; peeling off resection; portal vein tumor thrombus