Short-term and long-term outcomes of liver resection for HCC patients with portal vein tumor thrombus

Abstract

Background Portal vein tumor thrombosis (PVTT) in hepatocellular carcinoma (HCC) is a sign of advanced stage disease, which is associated with poor prognosis. Liver resection (LR) may provide better prognosis in selected patients. In the present study, we aimed to assess information from HCC patients with PVTT who died within 3 months or 2 years after LR in order to identify preoperative factors correlated to short-term or long-term survival, by which inappropriate selection of patients for LR might be avoided in the future. Methods A retrospective cohort study consisting of 487 consecutive cases of HCC patients with PVTT was performed from 2008 to 2010 at Eastern Hepatobiliary Surgery Hospital. Medical records, including laboratory values, imaging results and treatment information, were obtained from participants. Study endpoints were survival at 3 months and 2 years post-hepatectomy. Logistic regression analysis was utilized to determine the significant pre-operative factors influencing short-term or long-term survival. Results In multivariable analysis, α-fetoprotein, total bilirubin and radiologic ascites were significantly associated with short-term survival, while α-fetoprotein level, clinical significant portal hypertension, extent of PVTT and tumor differentiation were factors significantly associated with long-term survival. Conclusions The independent risk factors of poor short-term survival were the liver function-associated, such as factors radiologic ascites and total bilirubin, while tumor differentiation indicating the tumor biology was associated with longer-term survival. In addition, α-fetoprotein was a risk factor associated with both short-term and longer-term survivals. Electronic supplementary material The online version of this article (10.1186/s13578-019-0285-z) contains supplementary material, which is available to authorized users.

Development of an ALBI and ascites based model to predict survival for BCLC Stage B hepatocellular carcinoma

“…Ascites are the most common rst symptom of liver decompensation, which seriously affects the prognosis of patients with cirrhosis (13). The ascites were evaluated to be independent risk factor for the survival of HCC patients, and has been incorporated into several HCCrelated risk models (13,14,16,18). Therefore there might be an over-simpli cation in the ALBI grade, and the ascites could be retained as the parameters for the assessing of the liver function.…”

“…And the ascites always predicted the prognosis more accurately than the albumin level in previous HCC related risk models. Additionally, the ascites have been incorporated into several HCC-related prognostic model (such as HCC with portal vein tumor thrombus, HCC after ablation, HCC after palliative treatments, and BCLC stage C HCC) (14)(15)(16)(17)(18). Therefore it appears arbitrary and crude that eliminating the ascites variable from the risk prediction model for BCLC stage B HCC patients.…”

Living donor liver transplantation for patients with advanced hepatocellular carcinoma

“…The prognosis of patients with HCC and PVTT is known to be deleterious [39] , and the BCLC recommendation indicates Sorafenib as the only treatment option [33,40] . However, depending on the PVTT classification, different treatment options are available and survival rates vary among the literature.…”

AXL Overexpression in Tumor-Derived Endothelial Cells Promotes Vessel Metastasis in Patients With Hepatocellular Carcinoma

“…Nonetheless, the Barcelona Clinic for Liver Cancer Staging System and Treatment Guidelines consider that HCC patients with PVTT have a low chance of a cure ( 8 ), and sorafenib is the only recommended therapeutic option ( 9 , 10 ). Therefore, PVTT is an extremely poor prognostic factor for HCC patients ( 2 , 3 , 11 , 12 ). The median survival time of HCC patients with PVTT ranges from 2.7 to 4.0 months, if left untreated ( 2 , 13 ).…”