Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2015; 21(1): 246-253
Published online Jan 7, 2015. doi: 10.3748/wjg.v21.i1.246
Post-hepatectomy survival in advanced hepatocellular carcinoma with portal vein tumor thrombosis
Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Toshiya Ochiai, Eigo Otsuji
Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Katsutoshi Shoda, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan
Toshiya Ochiai, Department of Surgery, North Medical Center Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan
Author contributions: Yamamoto Y, Ikoma H, Morimura R and Otsuji E designed the research; Yamamoto Y, Ikoma H, Morimura R, Katsutoshi S and Ochiai T performed the research; Yamamoto Y, Konishi H, Murayama Y, Komatsu S, Shiozaki A, Kuriu Y, Kubota T, Nakanishi M, Ichikawa D, Fujiwara H, Okamoto K, Sakakura C and Ochiai T contributed new reagents/analytic tools; Yamamoto Y, Ikoma H, Morimura R and Ochiai T analyzed the data; Yamamoto Y, Ikoma H and Morimura R wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hisashi Ikoma, MD, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 6028566, Japan. ikoma@koto.kpu-m.ac.jp
Telephone: +81-75-2515527 Fax: +81-75-2515522
Received: March 21, 2014
Peer-review started: March 21, 2014
First decision: May 13, 2014
Revised: June 7, 2014
Accepted: July 11, 2014
Article in press: July 11, 2014
Published online: January 7, 2015
Processing time: 292 Days and 5.2 Hours
Abstract

AIM: To analyze hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) using the tumor-node-metastasis (TNM) staging system.

METHODS: We retrospectively analyzed 372 patients with HCC who underwent hepatectomy between 1980 and 2009. We studied the outcomes of HCC patients with PVTT to evaluate the American Joint Committee on Cancer TNM staging system (7th edition) for stratifying and predicting the prognosis of a large cohort of HCC patients after hepatectomy in a single-center. Portal vein invasion (vp) 1 was defined as an invasion or tumor thrombus distal to the second branch of the portal vein, vp2 as an invasion or tumor thrombus in the second branch of the portal vein, vp3 as an invasion or tumor thrombus in the first branch of the portal vein, and vp4 as an invasion or tumor thrombus in the portal trunk or extending to a branch on the contralateral side.

RESULTS: The cumulative 5-year overall survival (5yrOS) and 5-year disease-free survival (5yrDFS) rates of the 372 patients were 58.3% and 31.3%, respectively. The 5yrDFS and 5yrOS of vp3-4 patients (n = 10) were 20.0%, and 30.0%, respectively, which was comparable with the corresponding survival rates of vp1-2 patients (P = 0.466 and 0.586, respectively). In the subgroup analysis of patients with macroscopic PVTT (vp2-4), the OS of the patients who underwent preoperative transarterial chemoembolization was comparable to that of patients who did not (P = 0.747). There was a significant difference in the DFS between patients with stage I HCC and those with stage II HCC (5yrDFS 39.2% vs 23.1%, P < 0.001); however, the DFS for stage II was similar to that for stage III (5yrDFS 23.1% vs 13.8%, P = 0.330). In the subgroup analysis of stage II-III HCC (n = 148), only alpha-fetoprotein (AFP) > 100 mg/dL was independently associated with DFS.

CONCLUSION: Hepatectomy for vp3-4 HCC results in a survival rate similar to hepatectomy for vp1-2. AFP stratified the stage II-III HCC patients according to prognosis.

Keywords: Hepatocellular carcinoma; Hepatectomy; Portal vein tumor thrombosis; Tumor-node-metastasis staging system; Alpha-fetoprotein

Core tip: Hepatectomy for selected patients with hepatocellular carcinoma (HCC) with portal vein invasion (vp) 3 or vp4 may result in a survival rate that is similar to that for hepatectomy in vp1 or vp2 patients. Alpha-fetoprotein (AFP) can stratify the stage II-III patients according to prognosis. If serum AFP is elevated in patients with stage II-III HCC, clinical trials involving neoadjuvant/adjuvant therapy should be considered.