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Actual long-term survival in HCC patients with portal vein tumor thrombus after liver resection: a nationwide study

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Abstract

Background

Liver resection for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) offers a chance of cure, although survival is often limited. The actual 3-year survival and its associated prognostic factors have not been reported.

Methods

A nationwide database of HCC patients with PVTT who underwent liver resection with ‘curative’ intent was analyzed. The clinicopathologic characteristics, the perioperative, and survival outcomes for the actual long-term survivors were compared with the non-long-term survivors (patients who died within 3 years of surgery). Univariable and multivariable regression analyses were performed to identify predictive factors associated with long-term survival outcomes.

Results

The study included 1590 patients with an actuarial 3-year survival of 16.6%, while the actual 3-year survival rate was 11.7%. There were 171 patients who survived for at least 3 years after surgery and 1290 who died within 3 years of surgery. Multivariable regression analysis revealed that total bilirubin > 17.1 μmol/l, AFP > 400 ng/ml, types of hepatectomy, extent of PVTT, intraoperative blood loss > 400 ml, tumor diameter > 5 cm, tumor encapsulation, R0 resection, liver cirrhosis, adjuvant TACE, postoperative early recurrence (< 1 year), and recurrence treatments were independent prognostic factors associated with actual long-term survival.

Conclusion

One in nine HCC patients with PVTT reached the long-term survival milestone of 3 years after resection. Major hepatectomy, controlling intraoperative blood loss, R0 resection, adjuvant TACE, and ‘curative’ treatment for initial recurrence should be considered for patients to achieve better long-term survival outcomes.

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Funding

This study was supported by the Key Project of Natural Science Foundation of China (No: 81730097); the National Key Basic Research Programme ‘973 project’ (No: 2015CB554000); the National Natural Science Foundation of China (No: 81602523); the Shanghai Municipal Health Bureau (No: SHDC12015106); and the Shanghai Science and Technology Committee (No: 134119a0200).

Author information

Author notes

  1. Zhen-Hua Chen, Xiu-Ping Zhang, and Yu-Gang Lu contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, People’s Republic of China

    Zhen-Hua Chen, Xiu-Ping Zhang, Wei-Xing Guo, Jie Shi, Joseph Lau & Shu-Qun Cheng

  2. Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, People’s Republic of China

    Yu-Gang Lu

  3. Department of Hepatobiliary Surgery, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, People’s Republic of China

    Le-Qun Li

  4. Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China

    Min-Shan Chen

  5. Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People’s Republic of China

    Tian-Fu Wen

  6. Department of General Surgery, Affiliated Provincial Hospital, Anhui Medical University, Hefei, People’s Republic of China

    Wei-Dong Jia

  7. Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, People’s Republic of China

    Wei-Dong Jia

  8. Department of Hepatic Surgery, Fujian Provincial Cancer Hospital, Fujian, People’s Republic of China

    Dong Zhou

  9. Department of Hepatobiliary Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, People’s Republic of China

    Jing Li

  10. Department of Hepatobiliary Surgery, Southern Affiliated to Hospital Southern Medical University, Guangdong, People’s Republic of China

    Ding-Hua Yang

  11. Department of Hepatobiliary Surgery, Foshan First People’s Hospital, Guangdong, People’s Republic of China

    Zuo-Jun Zhen

  12. Department of Hepatobiliary Surgery, Inner Mongolia People’s Hospital, Inner Mongolia, People’s Republic of China

    Yi-Jun Xia

  13. Department of Hepatobiliary Surgery, The No.940 Hospital of Joint Logistics Support Force, Gansu, People’s Republic of China

    Rui-Fang Fan

  14. Department of Hepatobiliary Surgery, Shanghai Public Health Center, Shanghai, People’s Republic of China

    Yang-Qing Huang

  15. Organ Transplant Center, Sichuan Provincial People’s Hospital, Sichuan, People’s Republic of China

    Yu Zhang

  16. Department of Oncology, The First People’s Hospital of Xuzhou, Jiangsu, People’s Republic of China

    Xiao-Jing Wu

  17. Department of General Surgery, Wenzhou People’s Hospital, Zhejiang, People’s Republic of China

    Yi-Ren Hu

  18. Department of Hepatic Surgery, General Hospital of Northern War Zone, Liaoning, People’s Republic of China

    Yu-Fu Tang

  19. Second Affiliated Hospital of Wenzhou Medical University, Zhejiang, People’s Republic of China

    Jian-Hua Lin

  20. Department of Hepatobiliary Surgery, Affiliated Hospital of Binzhou Medical College, Shandong, People’s Republic of China

    Fan Zhang

  21. LongYan First Hospital, Affiliated to Fujian Medical University, Fujian, People’s Republic of China

    Cheng-Qian Zhong

  22. Department of Hepatopancreatobiliary Surgical Oncology, Military Institution of Hepatopancreatobiliary Surgery, the First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853, China

    Xiu-Ping Zhang

  23. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, People’s Republic of China

    Joseph Lau

  24. Chinese Liver Cancer with Portal Vein Thrombus Consortium, Shanghai, People’s Republic of China

    Zhen-Hua Chen, Xiu-Ping Zhang, Le-Qun Li, Min-Shan Chen, Tian-Fu Wen, Wei-Dong Jia, Dong Zhou, Jing Li, Ding-Hua Yang, Zuo-Jun Zhen, Yi-Jun Xia, Rui-Fang Fan, Yang-Qing Huang, Yu Zhang, Xiao-Jing Wu, Yi-Ren Hu, Yu-Fu Tang, Jian-Hua Lin, Fan Zhang, Cheng-Qian Zhong, Wei-Xing Guo, Jie Shi, Joseph Lau & Shu-Qun Cheng

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  1. Zhen-Hua Chen
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Contributions

Shu-Qun Cheng, Wan Yee Lau, Zhen-Hua Chen, Xiu-Ping Zhang, Yu-Gang Lu, and Meng-Chao Wu contributed to conception and design, Shu-Qun Cheng contributed to financial support, Le-Qun Li, Min-Shan Chen,Tian-Fu Wen, Wei-Dong Jia, Dong Zhou, Jing Li, Ding-Hua Yang, Zuo-Jun Zhen, Yi-Jun Xia, Rui-Fang Fan, Yang-Qing Huang, Yu Zhang, Xiao-Jing Wu, Yi-Ren Hu, Yu-Fu Tang, Jian-Hua Lin, Fan Zhang, Cheng-Qian Zhong, Wei-Xing Guo, and Jie Shi contributed to provision of study materials or patients, Zhen-Hua Chen, Xiu-Ping Zhang, and Yu-Gang Lu contributed to collection and assembly of data, Zhen-Hua Chen, Xiu-Ping Zhang, and Yu-Gang Lu contributed to data analysis and interpretation, Zhen-Hua Chen, and Wan Yee Lau wrote the manuscript, all authors approved the final manuscript.

Corresponding author

Correspondence to Shu-Qun Cheng.

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Conflict of interest

No potential conflicts of interest were disclosed.

Ethical approval

This study was approved by the Institutional Ethics Committee of the Eastern Hepatobiliary Surgery Hospital, the Sun Yat-sen University Cancer Centre, the Affiliated Tumor Hospital of Guangxi Medical University, the West China Hospital, the Affiliated Provincial Hospital of Anhui Medical University, Fujian Provincial Cancer Hospital, Xinqiao Hospital, the Affiliated Southern Hospital of Southern Medical University, the Foshan First People’s Hospital, the Inner Mongolia People’s Hospital, the No.940 Hospital of Joint Logistics Support Force, the Shanghai Public Health Center, the Sichuan Provincial People’s Hospital, the First People’s Hospital of Xuzhou, the Wenzhou People’s Hospital, the General Hospital of Northern War Zone, the Second Affiliated Hospital of Wenzhou Medical University, the Affiliated Hospital of Binzhou Medical College, and the LongYan First Hospital Affiliated to Fujian Medical University.

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Chen, ZH., Zhang, XP., Lu, YG. et al. Actual long-term survival in HCC patients with portal vein tumor thrombus after liver resection: a nationwide study. Hepatol Int 14, 754–764 (2020). https://doi.org/10.1007/s12072-020-10032-2

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  • DOI: https://doi.org/10.1007/s12072-020-10032-2

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