An Eastern Hepatobiliary Surgery Hospital/Portal Vein Tumor Thrombus Scoring System as an Aid to Decision Making on Hepatectomy for Hepatocellular Carcinoma Patients With Portal Vein Tumor Thrombus: A Multicenter Study

Abstract

Portal vein tumor thrombus (PVTT) is a significant poor prognostic factor for hepatocellular carcinoma (HCC). Patients with PVTT limited to a first-order branch of the main portal vein (MPV) or above could benefit from negative margin (R0) liver resection (LR). An Eastern Hepatobiliary Surgery Hospital (EHBH)/PVTT scoring system was established to predict the prognosis of HCC patients with PVTT after R0 LR and guide selection of subgroups of patients that could benefit from LR. HCC patients with PVTT limited to a first-order branch of the MPV or above who underwent R0 LR as an initial therapy were included. The EHBH-PVTT score was developed from a retrospective cohort in the training cohort using a Cox regression model and validated in a prospective internal validation cohort and three external validation cohorts. There were 432 patients in the training cohort, 285 in the prospective internal validation cohort, and 286, 189, and 135 in three external validation cohorts, respectively. The score was calculated using total bilirubin, α-fetoprotein (AFP), tumor diameter, and satellite lesions. The EHBH-PVTT score differentiated two groups of patients (≤/>3 points) with distinct long-term prognoses (median overall survival [OS], 17.0 vs. 7.9 months; P < 0.001). Predictive accuracy, as determined by the area under the time-dependent receiver operating characteristic curves (AUCs; 0.680-0.721), was greater than that of the other commonly used staging systems for HCC and PVTT. Conclusion: The EHBH-PVTT scoring system was more accurate in predicting the prognosis of HCC patients with PVTT than other staging systems after LR. It selected appropriate HCC patients with PVTT limited to a first-order branch of the MPV or above for LR. It can be used to supplement the other HCC staging systems.

Prognostic model for identifying candidates for hepatectomy among patients with hepatocellular carcinoma and hepatic vein invasion

“…A recently developed EHBH‐PVTT scoring system has been reported, which can be used as an aid to decision‐making on LR in those with HCC and PVTT. For patients with HCC and PVTT limited to a first‐order branch of the main portal vein or above, R0 LR is recommended for those with an EHBH‐PVTT score of 3 or less. However, this scoring system cannot be used in patients with macroscopic HVTT (including IVCTT and coexisting PVTT).…”

“…Strengths of the EHBH‐HVTT prognostic model are: it was constructed based on a nationwide multicentre cohort with a large sample size; it showed stability and accuracy in predicting OS after LR in patients with HCC and HVTT; this model could be used to identify suitable candidates with HCC and HVTT for LR; non‐LR treatments should be recommended for patients in the high‐risk group according the EHBH‐HVTT model, although in a proportion of patients who undergo LR, postoperative adjuvant TACE could still be used to improve long‐term survival outcomes; the EHBH‐HVTT model could be used as a supplement to the EHBH‐PVTT scoring system to select suitable patients with macrovascular invasion for LR, and as an adjunct to other international staging systems to improve their prognostic ability in patients with HCC and HVTT.…”

“…However, these advanced HCC groups are usually heterogeneous, including patients with poor performance status, advanced features and severe associated medical conditions, thus explaining why such patients are not considered for LR. An Eastern Hepatobiliary Surgery Hospital (EHBH)–PVTT scoring system was recently developed as an aid to decision‐making regarding LR for patients with HCC and PVTT. HVTT is much rarer than PVTT.…”

An Eastern Hepatobiliary Surgery Hospital Microvascular Invasion Scoring System in Predicting Prognosis of Patients with Hepatocellular Carcinoma and Microvascular Invasion After R0 Liver Resection: A Large-Scale, Multicenter Study

“…Gastric fundus/esophagus varicosity, an indication of the degree of cirrhosis, was also found to be an independent factor of OS in this study. In addition, we used similar methods to develop an EHBH portal vein tumor thrombus (PVTT) scoring system as an aid to decision making on hepatectomy for patients with HCC with PVTT, which included four factors—total bilirubin, α‐fetoprotein, tumor diameter, and satellite lesions . However, in this EHBH‐MVI scoring system, we input the other factor of liver function, albumin, into univariate analysis ( p = .351), which indicated that the liver function may not be associated with prognosis in patients with MVI, probably because patients with HCC with MVI have relatively better liver function than patients with PVTT.…”

A Single-Center Retrospective and Descriptive Study of Hepatobiliary and Pancreatic Surgical Oncology during the COVID-19 Epidemic

“…Hepatobiliary pancreatic tumors are one of the most common cancers. 11,18 Patients with liver cancer, gallbladder cancer, or pancreatic cancer have a fast progression and poor prognosis. Our hepatobiliary pancreatic surgical oncology department performed 92 operations in February 1-29, 2020, during the most serious stage of the epidemic.…”