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

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126 Citations (Scopus)

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

Keywords

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

ASJC Scopus subject areas

  • Hepatology

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  • Cite this

    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, 65(5), 938-943. https://doi.org/10.1016/j.jhep.2016.05.044