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

Hepatol Int. 2020 Sep;14(5):754-764. doi: 10.1007/s12072-020-10032-2. Epub 2020 Apr 6.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Adjuvant TACE; Hepatocellular carcinoma; Kaplan–Meier method; Liver resection; Long-term survival; Management; Nationwide study; Portal vein tumor thrombus; Prognosis; Recurrence.

MeSH terms

  • Cancer Survivors / statistics & numerical data
  • Carcinoma, Hepatocellular* / epidemiology
  • Carcinoma, Hepatocellular* / pathology
  • Carcinoma, Hepatocellular* / surgery
  • China / epidemiology
  • Female
  • Hepatectomy* / adverse effects
  • Hepatectomy* / methods
  • Hepatectomy* / mortality
  • Humans
  • Liver Neoplasms* / epidemiology
  • Liver Neoplasms* / pathology
  • Liver Neoplasms* / surgery
  • Long Term Adverse Effects / epidemiology
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Neoplastic Cells, Circulating / pathology*
  • Portal Vein / pathology*
  • Retrospective Studies
  • Survival Rate
  • Thrombosis* / etiology
  • Thrombosis* / surgery