Analysis of surgical treatment and prognostic factors for hepatocellular carcinoma with portal vein tumor thrombus

Background: Hepatocellular carcinoma (HCC) was the most common primary malignant liver tumor. The portal vein thrombosis (PVTT) of 10-40% were detected when HCC is exactly diagnosed. The patients whose PVTT existed in main branch of portal vein had poor prognosis. Whether hepatectomy could improve the survival rate of patients of HCC with PVTT was currently unknown. This study was to explore the prognosis and affecting factors of HCC with PVTT after liver resection. Methods: The clinical data of 81 patients who were performed surgical treatment because of HCC with PVTT were analyzed retrospectively. All patients were followed up. Kaplan-Meier curve (log rank test) was used to survival analysis. The factor of P< 0.05 is entered into the model of Cox's proportional hazards regression to multivariate analyze the prognostic factors of HCC with PVTT after hepatectomy. Results: The median survival time of HCC with PVTT after hepatectomy was 11.0 months, and the disease-free survival (DFS) time of HCC with PVTT after hepatectomy was 4.2 months. During follow-up, HCC recurrence and metastasis were happened in 78 patients while intrahepatic recurrence and metastasis were happened in 56 patients (71.8%). The 2-year overall survival (OS) rates of patients who received the treatment of Sorafenib and transcatheter arterial chemoembolization (TACE) and symptomatic treatment after recurrence were 50.0%, 18.5% and 0% (P = 0.000), respectively. Multivariate analysis showed that surgical margins and Cheng's classification for PVTT were independent factors on the DFS time for patients of the HCC with PVVT, while histological differentiation, Cheng's classification for PVTT and the modalities were independent factors on the OS time. Subgroup analysis revealed that there were not statistically significant difference (P> 0.05) for the DFS and OS time of patients between the type I and II of the Cheng's classification for PVTT. However, there were significantly difference (P< 0.05) for the DFS and OS time of patients between of the type I and type II and between of type II and type III of the Cheng's classification for PVTT, respectively. Conclusions: Cheng's classification for PVTT and the mode of treatments after the recurrence were independent factors on the survival of patients of HCC with PVTT. The individual treatments based on multidisciplinary team (MDT) could effectively extend the survival time of patients of HCC with PVTT.