Surgical Treatment For Hepatocellular Carcinoma With Portal Vein Tumor Thrombus (Analysis Of 78 Cases)

Objective:To evaluate the effect and the clinical factors affecting prognosis in patients with hepatocellular(HCC) with portal vein tumor thrombus(PVTT) after surgery.Methods:The object of study were 78 patients who were underwent liver resection with postoperative diagnosis of HCC with PVTT in First Affiliated Hospital of Zhejing University School of Medicine from January 2011 to December 2014.The clinical data and review cases were retrospectively analyzed.We used Kaplan-Meier method to calculate the cumulative survival rate,used Log-Rank to test survival differences between groups and used Cox multiple factors regression analysis.Results:Amount the 78 patients,the median survival time was 12.0 months (95% CI: 6.9～17.1 months), the postoperative 1,2, and 3 year survival rates were 48.3%,28.3% and 18.4%.In this study we analyzed 17 possible related factors and preoperative HBsAg, gender, age, degree of differentiation of tumor, preoperative TACE, liver cirrhosis, tumor location, surgical removal of the range,intraoperative bleeding and operation time had no obvious correlation with survival (P> 0.05). Patients with preoperative HBVDNA negative median survival time was 19.0 months (95% CI:6.6-31.4 months), preoperative HBVDNA positive patients’median survival time was 7.0 months (95% CI:5.2-8.8 months), two groups of survival rate had significant difference (P= 0.001).Patients with single tumor median survival time was 18.0 months (95% CI:11.7-24.3 months), patients with multiple tumors median survival time was 7.0 months (95% CI:4.9-9.1 months), two groups of survival rate had significant difference (P= 0.003).Patients with preoperative AFP< 400μg/L median survival time was 18.0 months (95% CI:11.5-24.5 months), preoperative patients with AFP>400μg/L median survival time was 8.0 months (95% CI:6.3-9.7 months), two groups of survival rate had significant difference (P= 0.016).Patients with type I tumor thrombus median survival time was 18.0 months (95% CI:0.0-38.6 months), in patients with type II tumor thrombus median survival time was 12.0 months (95% CI: 5.5-18.5 months), in patients with typeⅢtumor thrombus median survival time was 4.0 months (95% CI:1.9-6.1 months), survival rate has a significant difference between the three groups (Ⅰ and ⅡP= 0.028,1 andⅢP= 0.000, II andBⅢP= 0.000).Patients without postoperative TACE median survival time was 5.0 months (95% CI:2.4-7.6 months), Patients with postoperative TACE median survival time was 16.0 months (95% CI:10.4-21.6 months), two groups of survival rate had significant difference (P= 0.002).Patients with tumor diameter< 5 cm median survival time was 17.0 months (95% CI:8.2-25.8), tumor patients with tumor diameter>5 cm median survival time was 9.0 months (95% CI:6.5 ～ 11.5 months), two groups of survival rate ha significant difference (P= 0.048).Patients with tumor without envelope median survival time was 9.0 months (95% CI:7.4～10.6 months), patients with tumor with envelope median survival time was 21.0 months (95% CI:12.4～29.6 months), two groups of survival rate had significant difference (P= 0.021).Cox multiple factors analysis showed that postoperative TACE,preoperative AFP, tumor thrombus type and postoperative tumor number were independent factors affecting the prognosis (P< 0.05).Conclusion:Surgery is an effective way of treating hepatocellular carcinoma with portal vein tumor thrombus.Preoperative HBVDNA, preoperative AFP concentration, number of tumor, tumor envelope, tumor size, tumor thrombus type and postoperative TACE affect the prognosis of patient with hepatocellular carcinoma with portal venous tumor thrombus after surgery.Postoperative TACE, preoperative AFP, tumor thrombus type and number of tumor were independent factors affecting the prognosis.For patients with type Ⅲ tumor thrombus surgery may not provide a better survival time.