Effectiveness of multimodality treatment for hepatocellular carcinoma patients with portal vein thrombosis: A real world experience

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths worldwide. Portal vein thrombosis (PVT) can induce intrahepatic metastasis, deteriorate liver reserves, and worsen the prognosis of HCC. Although systemic therapy is currently standard treatment, multimodality treatment is used in clinical practices. HCC patients with PVT registered in the Cancer center of Taipei Tzu-Chi Hospital from January 2010 to January 2016 were retrospectively enrolled. PVT was categorized according to Japanese Vp classification. A total of 101 HCC patients with PVT were included for final analysis. The 1-, 3-, or 5-year survival rate was 33.7%, 11.9%, or 5%, respectively. The median overall survival was significantly better in HCC patients with branch PVT (BPV) than those with main PVT (MPV) (7 vs 4.8 months, P = .009) and in those receiving surgical resection than those without (12.8 vs 5.6 months, P < .001). Using Cox regression analysis after adjustment with confounding factors, surgical resection was the only favorable predictor of a survival rate (hazard ratio 0.14; 95% confidence interval 0.05-0.38) in HCC patients with PVT. In conclusion, the overall survival was better in HCC patients with branch PVT and those receiving surgical resection. Surgical resection is the only favorable predictor of overall survival for HCC patients with PVT rather than other multimodality treatment including sorafenib, suggesting surgical resection is not contra-indicated for HCC patients with PVT especially branch type PVT.