Analysis of prognostic factors in patients with hepatocellular carcinoma combined with portal vein tumor thrombus after surgical resection / 中华肝胆外科杂志

ABSTRACT

Objective:To analyze prognostic factors of hepatocellular carcinoma (HCC) combined with portal vein tumor thrombus (PVTT) after surgical resection.Methods:The data of 98 patients with HCC combined with PVTT who underwent surgical resection in Ningbo University Affiliated Li Huili Hospital from January 2008 to June 2019 were analyzed retrospectively, including 83 males and 15 females with an average age of 53 years. The survival rate was calculated by Kaplan-Meier method and compared using log-rank test. Cox regression model was used for the multivariate analysis of the prognosis of patients.Results:The 1, 2, and 3-year overall survival rates were 75.9%, 51.5%, and 35.4%, respectively, with a median survival time of 25 months; the 1, 2, and 3-year disease-free survival rates were 35.0%, 16.1%, and 8.6%, respectively, with a median disease-free survival time of 8 months. Multivariate analysis showed that the overall survival of patients with preoperative alpha-fetoprotein (AFP) ≥400 μg/L ( HR=1.760, 95% CI 1.079-2.873) and hepatic vein tumor thrombus (HVTT, HR=3.809, 95% CI 1.655-8.765) was poorer after surgical resection (all P<0.05), while the survival of patients with postoperative adjuvant trans-arterial chemoembolization (TACE) ( HR=0.397, 95% CI 0.220-0.716, P=0.002) was better. Preoperative AFP≥400 μg/L ( HR=2.339, 95% CI 1.488-3.676) , undergoing HCC resection combined with PVTT dissection ( HR=2.038, 95% CI 1.090-3.811), and with HVTT ( HR=2.374, 95% CI 1.160-4.857) (all P<0.05) are independent risk factors for recurrence in patients with HCC combined with PVTT, postoperative adjuvant TACE ( HR=0.535, 95% CI 0.307-0.933, P=0.027) is a protective factor. Conclusion:Preoperative AFP≥400 μg/L and HVTT are independent risk factors for the prognosis of patients with HCC combined with PVTT. Reasonable selection of surgical methods and postoperative adjuvant TACE may improve the prognosis of patients.