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J Hepatol. 2016 Nov;65(5):938-943. doi: 10.1016/j.jhep.2016.05.044. Epub 2016 Jun 4.

Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion.

Author information

1
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan; Division of Gastroenterological Surgery, Saitama Cancer Center, Japan.
2
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan.
3
Department of Biostatistics, School of Public Health, The University of Tokyo, Japan.
4
Department of Digestive Surgery, Nihon University School of Medicine, Japan.
5
Department of Gastroenterology, Musashino Red Cross Hospital, Japan.
6
Department of Radiology, Shinshu University School of Medicine, Japan.
7
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Japan.
8
Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Japan.
9
Department of Pathology, Keio University School of Medicine, Japan.
10
Department of Clinical Laboratory Medicine, Kurume University Hospital, Japan.
11
Department of Gastroenterology, Kanazawa University Hospital, Japan.
12
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan. Electronic address: KOKUDO-2SU@h.u-tokyo.ac.jp.

Abstract

BACKGROUND & AIMS:

The presence of portal vein tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC) is regarded as indicating an advanced stage, and liver resection (LR) is not recommended. The aim of this study was to evaluate the survival benefit of LR for HCC patients with PVTT through the analysis of the data from a Japanese nationwide survey.

METHODS:

We analyzed data for 6474 HCC patients with PVTT registered between 2000 and 2007. Of these patients, 2093 patients who underwent LR and 4381 patients who received other treatments were compared. The propensity scores were calculated and we successfully matched 1058 patients (66.1% of the LR group).

RESULTS:

In the Child-Pugh A patients, the median survival time (MST) in the LR group was 1.77years longer than that in the non-LR group (2.87years vs. 1.10years; p<0.001) and 0.88years longer than that in the non-LR group (2.45years vs. 1.57years; p<0.001) in a propensity score-matched cohort. A subgroup analysis revealed that LR provides a survival benefit regardless of age, etiology of HCC, tumor marker elevation, and tumor number. The survival benefit was not statistically significant only in patients with PVTT invading the main trunk or contralateral branch. In the LR group, the postoperative 90-day mortality rate was 3.7% (68 patients).

CONCLUSIONS:

As long as the PVTT is limited to the first-order branch, LR is associated with a longer survival outcome than non-surgical treatment.

LAY SUMMARY:

The presence of portal vein tumor thrombosis in patients with hepatocellular carcinoma is regarded as indicating an advanced stage, and liver resection is not recommended. We performed a multicenter, nationwide study to assess the survival benefit of liver resection in hepatocellular carcinoma patients with portal vein tumor thrombosis using propensity score-based matching. As long as the portal vein tumor thrombosis is limited to the first-order branch, liver resection is associated with a longer survival outcome than non-surgical treatment.

KEYWORDS:

Hepatocellular carcinoma; Liver resection; Nationwide survey; Portal vein tumor thrombosis; Propensity score-match

PMID:
27266618
DOI:
10.1016/j.jhep.2016.05.044
[Indexed for MEDLINE]

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