Hepatocellular carcinoma with portal tumor thrombus: analysis of factors determining prognosis.

For 104 consecutive patients with hepatocellular carcinoma (HCC) with portal tumor thrombus (PTT) seen in the past nine years, prognostic factors were analyzed retrospectively using Cox's multivariate analysis. There was a significant difference in survival rate with hepatic functional reserve (Child classification, P = 0.005), type of treatment (surgical vs non-surgical treatment, P = 0.009) and PTT grade (P = 0.04). The survival rates for patients with Child's A (n 49) or Child's B (n 55) were 60.8 vs 20.0% at one year, 41.6 vs 9.1% at two years and 35.4 vs 5.5% at three years. The survival rates of patients with surgical (n 32) and non-surgical (n 72) therapy were 71.7 vs 25.0% at one year, 58.5 vs 9.4% at two years and 53.6 vs 4.7% at three years. Among patients with PTT grades in the third or lower order branch (Vp1, n 29), the second order branch (Vp2, n 32) and the first or portal vein trunk (Vp3, n 43), the one-year, two-year and three-year survival rates were 61.6, 43.8 and 20.9%; 47.1, 27.5 and 6.2% and 42.8, 27.5 and 0%, respectively. When analysis was focused on 32 patients with Child's A and PTT (Vp1 plus Vp2) with respect to treatment, the survival rates in the surgical (n 22) and nonsurgical (n 10) groups were 86.1 vs 70.0% at one year, 71.5 vs 30.0% at two years and 64.3 vs 20.0% at three years (P < 0.05), respectively. In HCC patients with PTT, surgery seems to be indicated where hepatic function is well preserved and the PTT is localized in a peripheral portal branch.