Effects Of PVTT Type On Long-term Outcomes Of HCC Resection

Objectives In patients of HCC, up to12.9-39.7percents are complicated with portal vein tumor thrombosis(PVTT). PVTT is a key factor for poor prognosis,which can lead to intrahepatic metastasis and portal hypertension. Scholars have tried various treatments in an attempt to improve short-term prognosis, but so far no standard protocol is reached. There is still lack of consensus on surgical treatment of HCC complicated with PVTT as to its indications, contradictions and long-term prognosis. We carried out a retrospective study of preoperative, intraoperative and postoperative data of patients of different types of PVTT in order to explore the effects of PVTT on long-term outcomes of HCC resection and analyzed prognostic factors.Materials and methods Retrospectively analyze the203patients who underwent hepatic resection with or without portal thrombectomy for HCC with PVTT at Qilu hospital of Shandong University during January2010to December2012. According to the classification of Liver Cancer Study Group of Japan, PVTT are divied into four types:VP1(PVTT locates distal to the second branch of portal vein), VP2(PVTT invades the second branch of portal vein), VP3(PVTT invades the first branch of portal vein), VP4(PVTT invades the main portal trunk or first branches of both sides). Analyze the clinical characteristics, occurrence and survival rates. SPSS18.0statistical software package was used, P (0.05is statistically significant.Results According to the intraoperative data, as the type went from VP1to VP4, operation time and duration of vascular clamping were longer, median intraoperative blood loss and median perioperative blood transfusion were larger. According to the postoperative data, complication rate is30.0%. At a median follow up of6.5(2-59)months, the1-and3-year overall survival rates were33.5%and12.8%respectively, the1-and3-year disease-free survival rates were10.8%and3.0%. The overall survival rate of VP4patients was significantly lower than those of VP1,VP2and VP3patients (P<0.01), the differences of overall survival rates among VP1,VP2and VP3patients are statistically significant. Also, the disease-free survival rate of VP4patients was significantly lower than those of VP1,VP2and VP3patients (P <0.01), the differences of disease-free survival rates among VP1,VP2and VP3patients are statistically significant.Using univariate analysis, factors correlate negatively with survival are VP4type, positivity of HBsAg, AFP〉20ng/mL and tumor diameter〉5cm. On multivariate analysis, PVTT typing, AFP〉20ng/mL and tumor diameter〉5cm are independent predictors of poor survival.Conlusions For HCC with PVTT, long-term outcome of surgical treatment is directly related with PVTT typing. VP4pantients has a much worse prognosis and much more operation risk than patients of the other three types. We advocate a relatively aggressive approach when it comes to patients of the other three types, as they have relatively high survival rates and low complication rates, whereas take a prudent aproach towards VP4patients.