TY - JOUR
T1 - Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion
AU - Kokudo, Takashi
AU - Hasegawa, Kiyoshi
AU - Matsuyama, Yutaka
AU - Takayama, Tadatoshi
AU - Izumi, Namiki
AU - Kadoya, Masumi
AU - Kudo, Masatoshi
AU - Ku, Yonson
AU - Sakamoto, Michiie
AU - Nakashima, Osamu
AU - Kaneko, Shuichi
AU - Kokudo, Norihiro
N1 - Funding Information:
The study’s baseline survey was funded by the Grant-in-aid for a nationwide follow-up survey of primary liver cancer.
Publisher Copyright:
© 2016 European Association for the Study of the Liver
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background & Aims The presence of portal vein tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC) is regarded as indicating an advanced stage, and liver resection (LR) is not recommended. The aim of this study was to evaluate the survival benefit of LR for HCC patients with PVTT through the analysis of the data from a Japanese nationwide survey. Methods We analyzed data for 6474 HCC patients with PVTT registered between 2000 and 2007. Of these patients, 2093 patients who underwent LR and 4381 patients who received other treatments were compared. The propensity scores were calculated and we successfully matched 1058 patients (66.1% of the LR group). Results In the Child-Pugh A patients, the median survival time (MST) in the LR group was 1.77 years longer than that in the non-LR group (2.87 years vs. 1.10 years; p <0.001) and 0.88 years longer than that in the non-LR group (2.45 years vs. 1.57 years; p <0.001) in a propensity score-matched cohort. A subgroup analysis revealed that LR provides a survival benefit regardless of age, etiology of HCC, tumor marker elevation, and tumor number. The survival benefit was not statistically significant only in patients with PVTT invading the main trunk or contralateral branch. In the LR group, the postoperative 90-day mortality rate was 3.7% (68 patients). Conclusions As long as the PVTT is limited to the first-order branch, LR is associated with a longer survival outcome than non-surgical treatment. Lay summary The presence of portal vein tumor thrombosis in patients with hepatocellular carcinoma is regarded as indicating an advanced stage, and liver resection is not recommended. We performed a multicenter, nationwide study to assess the survival benefit of liver resection in hepatocellular carcinoma patients with portal vein tumor thrombosis using propensity score-based matching. As long as the portal vein tumor thrombosis is limited to the first-order branch, liver resection is associated with a longer survival outcome than non-surgical treatment.
AB - Background & Aims The presence of portal vein tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC) is regarded as indicating an advanced stage, and liver resection (LR) is not recommended. The aim of this study was to evaluate the survival benefit of LR for HCC patients with PVTT through the analysis of the data from a Japanese nationwide survey. Methods We analyzed data for 6474 HCC patients with PVTT registered between 2000 and 2007. Of these patients, 2093 patients who underwent LR and 4381 patients who received other treatments were compared. The propensity scores were calculated and we successfully matched 1058 patients (66.1% of the LR group). Results In the Child-Pugh A patients, the median survival time (MST) in the LR group was 1.77 years longer than that in the non-LR group (2.87 years vs. 1.10 years; p <0.001) and 0.88 years longer than that in the non-LR group (2.45 years vs. 1.57 years; p <0.001) in a propensity score-matched cohort. A subgroup analysis revealed that LR provides a survival benefit regardless of age, etiology of HCC, tumor marker elevation, and tumor number. The survival benefit was not statistically significant only in patients with PVTT invading the main trunk or contralateral branch. In the LR group, the postoperative 90-day mortality rate was 3.7% (68 patients). Conclusions As long as the PVTT is limited to the first-order branch, LR is associated with a longer survival outcome than non-surgical treatment. Lay summary The presence of portal vein tumor thrombosis in patients with hepatocellular carcinoma is regarded as indicating an advanced stage, and liver resection is not recommended. We performed a multicenter, nationwide study to assess the survival benefit of liver resection in hepatocellular carcinoma patients with portal vein tumor thrombosis using propensity score-based matching. As long as the portal vein tumor thrombosis is limited to the first-order branch, liver resection is associated with a longer survival outcome than non-surgical treatment.
KW - Hepatocellular carcinoma
KW - Liver resection
KW - Nationwide survey
KW - Portal vein tumor thrombosis
KW - Propensity score-match
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U2 - 10.1016/j.jhep.2016.05.044
DO - 10.1016/j.jhep.2016.05.044
M3 - Article
C2 - 27266618
AN - SCOPUS:84994494466
SN - 0168-8278
VL - 65
SP - 938
EP - 943
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 5
ER -