Optimal surgical strategy for hepatocellular carcinoma with portal vein tumor thrombus: A propensity score analysis

// Yong-Fa Zhang 1,2,3,* , Yong Le 1,2,3,* Wei Wei 1,2,3,* , Ru-Hai Zou 1,3,4,* , Jia-Hong Wang 1,2,3 , Han-Yue OuYang 1,2,3 , Cheng-Zuo Xiao 5 , Xiao-Ping Zhong 1,2,3 , Ming Shi 1,2,3 and Rong-Ping Guo 1,2,3 1 Department of Hepatobiliary Oncology of Sun Yat-sen University Cancer Center, Guangzhou, P.R. China 2 State Key Laboratory of Oncology in South China, Guangzhou, P.R. China 3 Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China 4 Department of Ultrasonography of Sun Yat-sen University Cancer Center, Guangzhou, P.R. China 5 Department of General surgery, Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University, Shenzhen, P.R. China * These authors have contributed equally to this work Correspondence to: Rong-Ping Guo, email: // Ming Shi, email: // Keywords : hepatocellular carcinoma, portal vein tumor thrombus, hepatic resection, en bloc resection, peeling off resection Received : October 22, 2015 Accepted : March 29, 2016 Published : April 07, 2016 Abstract Objectives: The optimal surgical resection method for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) that maximizes both safety and long-term outcome has not yet been determined. The aim of this study was to compare the clinical outcomes following peeling off versus en bloc resection for PVTT. Methods: From 2005 to 2012, 252 patients with HCC and type I/II PVTT who underwent hepatic resection were divided into two groups according to whether they received en bloc resection ( n = 113) or peeling off resection ( n = 139). The clinical outcomes were compared before and after propensity score matching. Results: The propensity model matched 113 patients with en bloc resection for further analyses. After matching, overall survival (OS) and disease-free survival (DFS) rates were significantly increased in the en bloc group compared with the peeling off group ( p = 0.011 and p = 0.015). A multivariate analysis indicated that en bloc resection independently improved both OS and DFS (HR = 1.471, 95% CI: 1.071-2.018, p = 0.017 and HR = 1.415, 95% CI: 1.068-1.874, P =0.016). The adverse events were not significantly different between the two groups. However, the peeling off group showed a significantly increased recurrence rate of vascular invasion compared with the en bloc group (23.9% vs . 9.7%, p = 0.005). Similar results were also demonstrated prior to the matched analysis. Conclusions: An en bloc resection is safe and confers a survival advantage compared with a peeling off resection in HCC patients with PVTT; thus, en bloc resection should be recommended as a standard treatment for these patients when possible.