Zhen-Hua Chen1,2, Xiu-Ping Zhang1,3,2, Yu-Gang Lu4, Le-Qun Li5,2, Min-Shan Chen6,2, Tian-Fu Wen7,2, Wei-Dong Jia8,9,2, Dong Zhou10,2, Jing Li11,2, Ding-Hua Yang12,2, Zuo-Jun Zhen13,2, Yi-Jun Xia14,2, Rui-Fang Fan15,2, Yang-Qing Huang16,2, Yu Zhang17,2, Xiao-Jing Wu18,2, Yi-Ren Hu19,2, Yu-Fu Tang20,2, Jian-Hua Lin21,2, Fan Zhang22,2, Cheng-Qian Zhong23,2, Wei-Xing Guo1,2, Jie Shi1,2, Joseph Lau1,24,2, Shu-Qun Cheng25,26. 1. Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, People's Republic of China. 2. Chinese Liver Cancer with Portal Vein Thrombus Consortium, Shanghai, People's Republic of China. 3. Department of Hepatopancreatobiliary Surgical Oncology, Military Institution of Hepatopancreatobiliary Surgery, the First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853, China. 4. Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People's Republic of China. 5. Department of Hepatobiliary Surgery, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, People's Republic of China. 6. Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China. 7. Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China. 8. Department of General Surgery, Affiliated Provincial Hospital, Anhui Medical University, Hefei, People's Republic of China. 9. Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, People's Republic of China. 10. Department of Hepatic Surgery, Fujian Provincial Cancer Hospital, Fujian, People's Republic of China. 11. Department of Hepatobiliary Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, People's Republic of China. 12. Department of Hepatobiliary Surgery, Southern Affiliated to Hospital Southern Medical University, Guangdong, People's Republic of China. 13. Department of Hepatobiliary Surgery, Foshan First People's Hospital, Guangdong, People's Republic of China. 14. Department of Hepatobiliary Surgery, Inner Mongolia People's Hospital, Inner Mongolia, People's Republic of China. 15. Department of Hepatobiliary Surgery, The No.940 Hospital of Joint Logistics Support Force, Gansu, People's Republic of China. 16. Department of Hepatobiliary Surgery, Shanghai Public Health Center, Shanghai, People's Republic of China. 17. Organ Transplant Center, Sichuan Provincial People's Hospital, Sichuan, People's Republic of China. 18. Department of Oncology, The First People's Hospital of Xuzhou, Jiangsu, People's Republic of China. 19. Department of General Surgery, Wenzhou People's Hospital, Zhejiang, People's Republic of China. 20. Department of Hepatic Surgery, General Hospital of Northern War Zone, Liaoning, People's Republic of China. 21. Second Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China. 22. Department of Hepatobiliary Surgery, Affiliated Hospital of Binzhou Medical College, Shandong, People's Republic of China. 23. LongYan First Hospital, Affiliated to Fujian Medical University, Fujian, People's Republic of China. 24. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, People's Republic of China. 25. Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, People's Republic of China. chengshuqun@aliyun.com. 26. Chinese Liver Cancer with Portal Vein Thrombus Consortium, Shanghai, People's Republic of China. chengshuqun@aliyun.com.
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.
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 HCCpatients 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 HCCpatients 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.