Outcome Analysis Of Tumor Thrombi In The Portal Vein For Hepatocellular Carcinoma Patients

BackgroundPrimary hepatocelluar carcinoma,one of the most common malignant tumor in China, can easily invade portal vein to cause portal vein tumor thrombus(hereinafter referred to PVTT) after portal venous metastasis when the tumor grows to some extent. Although at present hepatocarcinoma typing and staging is widely used in clinical practice,there is still a lack of hepatocarcinoma typing and staging for PVTT.Even though the clinically authoritative and widely used hepatocarcinoma staging,such as TNM staging by UICC,CLIP score system in Italy,JIS score system in Japan,etc., include PVTT as an important parameter for hepatocarcinoma staging and scoring, they only consider the presence or non-presence of PVTT,without further stratification and refinement.And thus they all fail to establish diagnostic standards against different PVTT subtypes,accordingly unable to make more detailed prognosis and of clinical significance guidance.The group led by Professor Cheng Shuqun is the first one at home and abroad who in 2004 classified tumor thrombi intoⅠ-Ⅳsubtypes based on the degree of progress(different portal vein invasion).This typing method which objectively reflects the relation between different tumor thrombus stages and prognosis has a good clinical significance guidance for the prognosis analysis of the tumor thrombus patients with different types.Based on the standards for PVTTⅠ-Ⅳtyping put forth by Professor Cheng,a systemic study with large samples was done on the hepatocarcinoma patients with PVTT who were hospitalized and underwent surgeries during the period of January 2000 to December 2003 in our hospital. Comprehensive investigations on pre-surgery examination of the hepatocarcinoma patients with PVTT,tumor characteristics and tumor thrombus features,as well as pathological features and after-surgery treatment etc.,were carried out,statistical analysis was done of the timing of tumor recurrence and tumor thrombus recurrence as well as the survival time of the patients.Survival analysis was also done on the patient with different tumor thrombus types by comparing with TNM staging,CLIP scoring system and JIS scoring system.Objective:The present study is to further verify the applicability of portal vein tumor thrombus by discussing the surgical efficacy of tumor thrombus with different typing methods. The study also aims to aid in the more scientific and detailed prediction of the prognosis of portal vein tumor thrombus,and provide guidance and reference standards for clinical diagnosis of hepatocarcinoma with portal vein tumor thrombus by discussing the clinical stratification of the typing of primary hepatocelluar carcinoma with portal vein tumor thrombus.Method:Retrospective analysis was done on 406 hepatocarcinoma patients with portal vein tumor thrombus who were hospitalized and had undergone surgeries during the period of January 2000 to December 2003 in our hospital.Tumor thrombi were defined as typeⅠ-Ⅳaccording to the typing standards of the tumor thrombus set by Professor Cheng.Follow-up study was done on all patients.Analysis of survival time was carried out by using portal vein tumor thrombus typing,TNM staging,CLIP scoring system and JIS scoring system,and survival curve was plotted.The stratification capability and prognosis predictability of each system was also compared.The TNM staging suitable for portal vein tumor thrombus typing was found out by plotting survival curve of the patients with portal vein tumor thrombus and combined analysis of the TNM staging and portal vein tumor thrombus typing.Result;With portal vein tumor thrombus typing,the 1,2,3 years survival rates were 52.1%, 31.8%and 25.1%respectivly for typeⅠpatients;38.2%,26.6%and 17.7% respectively for typeⅡpatients;24.7%,11.4%and 3.6%respectively for typeⅢpatients;and 18.3%,0%and 0%respectivly in typeⅣpatients.The Log-Rank of various types' survival curve was P＜.0001.With TNM staging,the 1,2,3 years survival rates were 55.4%,37.5%and 30.5% respectively for typeⅡpatients,36.4%,21.8%and 12.8%respectively for typeⅢpatients;0%,0%and 0%respectively for typeⅣpatients.The Log-Rank of various types' survival curve was P＜.0001.With CLIP scoring system,the 1,2,3 years survival rates were 61.5%,46.5%and 40.7%respectively for patients had 1 score;38.0%,20.3%and 14.5%respectively for patients had 2 scores;36.7%,21.8%and 13.7%respectively for patients had 3 scords;28.8%,16.4%and 8.2%respectively for patients had 4 scords;and 0%,0 %and 0%respectively for patients had 5 scords.The Log-Rank of various types' survival curve was P＜.0001.With JIS scoring system,the 1,2,3 years survival rates were 55.6%,36.4%and 32.4 %respectively for patients had 1 score;36.0%,21.6%and 13.6%respectively for patients had 2 score;39.1%,23.0%and 11.2%respectively for patients had 3 score;and 0%,0%and 0%respectively for patients had 4 score,The Log-Rank of various types' survival curve was P =0.0158.DiscussionPortal vein tumor thrombus typing is better capable of stratifying portal vein tumor thrombus and predicting the prognosis compared with other staging systems because it can represent different development stages of tumor thrombus.TNM staging combined with tumor thrombus typing provides a better clinical reference standard and guidance on the treatment of the patients with portal vein tumor thrombus and the recurrence treatment after surgery since it can more objectively reflect the prognosis of the patients with portal vein tumor thrombus of different types and compensating the deficiency with TNM staging.