Actual long-term survival in HCC patients with portal vein tumor thrombus after liver resection: a nationwide study

• DOI: 10.1007/s12072-020-10032-2
• Publication Date: 2020-04-06T19:03:46Z
• Authors: Zhen-Hua Chen; Xiu-Ping Zhang; Yu-Gang Lu; Le-Qun Li; Min-Shan Chen; Tian-Fu Wen; Wei-Dong Jia; Dong Zhou; Jing Li; Ding-Hua Yang; Zuo-Jun Zhen; Yi-Jun Xia; Rui-Fang Fan; Yang-Qing Huang; Yu Zhang; Xiao-Jing Wu; Yi-Ren Hu; Yu-Fu Tang; Jian-Hua Lin; Fan Zhang; Cheng-Qian Zhong; Wei-Xing Guo; Jie Shi; Joseph Lau; Shu-Qun Cheng
• Keywords: Colorectal Surgery; Surgical oncology

Liver resection for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) offers a chance of cure, although survival is often limited. The actual 3-year survival and its associated prognostic factors have not been reported.A nationwide database of HCC patients with PVTT who underwent liver resection with 'curative' intent was analyzed. The clinicopathologic characteristics, the perioperative, and survival outcomes for the actual long-term survivors were compared with the non-long-term survivors (patients who died within 3 years of surgery). Univariable and multivariable regression analyses were performed to identify predictive factors associated with long-term survival outcomes.The study included 1590 patients with an actuarial 3-year survival of 16.6%, while the actual 3-year survival rate was 11.7%. There were 171 patients who survived for at least 3 years after surgery and 1290 who died within 3 years of surgery. Multivariable regression analysis revealed that total bilirubin > 17.1 μmol/l, AFP > 400 ng/ml, types of hepatectomy, extent of PVTT, intraoperative blood loss > 400 ml, tumor diameter > 5 cm, tumor encapsulation, R0 resection, liver cirrhosis, adjuvant TACE, postoperative early recurrence (< 1 year), and recurrence treatments were independent prognostic factors associated with actual long-term survival.One in nine HCC patients with PVTT reached the long-term survival milestone of 3 years after resection. Major hepatectomy, controlling intraoperative blood loss, R0 resection, adjuvant TACE, and 'curative' treatment for initial recurrence should be considered for patients to achieve better long-term survival outcomes.