Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion

Takashi Kokudo, Kiyoshi Hasegawa, Yutaka Matsuyama, Tadatoshi Takayama, Namiki Izumi, Masumi Kadoya, Masatoshi Kudo, Yonson Ku, Michiie Sakamoto, Osamu Nakashima, Shuichi Kaneko, Norihiro Kokudo

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)938-943
Number of pages6
JournalJournal of Hepatology
Volume65
Issue number5
DOIs
Publication statusPublished - 2016 Nov 1

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Portal Vein
Hepatocellular Carcinoma
Survival
Liver
Thrombosis
Neoplasms
Propensity Score
Tumor Biomarkers
Multicenter Studies
Therapeutics

Keywords

  • Hepatocellular carcinoma
  • Liver resection
  • Nationwide survey
  • Portal vein tumor thrombosis
  • Propensity score-match

ASJC Scopus subject areas

  • Hepatology

Cite this

Kokudo, T., Hasegawa, K., Matsuyama, Y., Takayama, T., Izumi, N., Kadoya, M., ... Kokudo, N. (2016). Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion. Journal of Hepatology, 65(5), 938-943. https://doi.org/10.1016/j.jhep.2016.05.044

Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion. / Kokudo, Takashi; Hasegawa, Kiyoshi; Matsuyama, Yutaka; Takayama, Tadatoshi; Izumi, Namiki; Kadoya, Masumi; Kudo, Masatoshi; Ku, Yonson; Sakamoto, Michiie; Nakashima, Osamu; Kaneko, Shuichi; Kokudo, Norihiro.

In: Journal of Hepatology, Vol. 65, No. 5, 01.11.2016, p. 938-943.

Research output: Contribution to journalArticle

Kokudo, T, Hasegawa, K, Matsuyama, Y, Takayama, T, Izumi, N, Kadoya, M, Kudo, M, Ku, Y, Sakamoto, M, Nakashima, O, Kaneko, S & Kokudo, N 2016, 'Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion', Journal of Hepatology, vol. 65, no. 5, pp. 938-943. https://doi.org/10.1016/j.jhep.2016.05.044
Kokudo, Takashi ; Hasegawa, Kiyoshi ; Matsuyama, Yutaka ; Takayama, Tadatoshi ; Izumi, Namiki ; Kadoya, Masumi ; Kudo, Masatoshi ; Ku, Yonson ; Sakamoto, Michiie ; Nakashima, Osamu ; Kaneko, Shuichi ; Kokudo, Norihiro. / Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion. In: Journal of Hepatology. 2016 ; Vol. 65, No. 5. pp. 938-943.
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title = "Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion",
abstract = "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.",
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author = "Takashi Kokudo and Kiyoshi Hasegawa and Yutaka Matsuyama and Tadatoshi Takayama and Namiki Izumi and Masumi Kadoya and Masatoshi Kudo and Yonson Ku and Michiie Sakamoto and Osamu Nakashima and Shuichi Kaneko and Norihiro Kokudo",
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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

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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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