Clinical Research Papers:
Optimal surgical strategy for hepatocellular carcinoma with portal vein tumor thrombus: A propensity score analysis
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Yong-Fa Zhang1,2,3,*, Yong Le1,2,3,* Wei Wei1,2,3,*, Ru-Hai Zou1,3,4,*, Jia-Hong Wang1,2,3, Han-Yue OuYang1,2,3, Cheng-Zuo Xiao5, Xiao-Ping Zhong1,2,3, Ming Shi1,2,3 and Rong-Ping Guo1,2,3
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
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
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.
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