Influencing factors for prognosis of patients with hepatocellular carcinoma complicated with portal vein tumor thrombus after surgical treatment

doi:10.3877/cma.j.issn.2095-3232.2016.04.011

Abstract

Abstract:

Objective

To investigate the influencing factors for the prognosis of patients with hepatocellular carcinoma (HCC) complicated with portal vein tumor thrombus (PVTT) after surgical treatment.

Methods

Clinical data of 32 patients with HCC and PVTT who underwent surgical treatments in Tianjin Medical University Cancer Institute and Hospital between June 2010 and June 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 25 males and 7 females, aged from 35 to 75 years old with a median age of 66 years old. The 1-, 2-, 3-year cumulative survival and recurrence-free survival of the patients were observed, and independent risk factors for the overall and recurrence-free survival were analyzed. Survival analysis was conducted using Kaplan-Meier method and Log-rank test. Multivariate analysis was conducted using Cox proportional hazard regression model.

Results

The median survival time was 18 months, and the 1-, 2- , 3-year cumulative survival was respectively 62.5%, 43.5% and 33.5%. The median recurrence-free survival time was 6 months, and the 1-, 2-, 3-year recurrence-free survival was respectively 37.5%, 18.2% and 10.9%. Multivariate analysis revealed that PVTT staging (RR=4.632, 95%CI: 1.528-14.039; P<0.05), surgical procedure (RR=4.928, 95%CI:1.233-19.696; P<0.05) and treatments after recurrence (RR=21.069, 95%CI:3.529-125.806; P<0.05) were the independent influencing factors for postoperative overall survival. Treatments to prevent recurrence was the independent influencing factor for postoperative recurrence-free survival (RR=4.486, 95%CI: 1.807-11.138; P<0.05).

Conclusions

Surgical treatments has certain clinical application value for HCC complicated with PVTT. PVTT staging, surgical procedure and treatments after recurrence are the independent influencing factors for postoperative overall survival. And treatments to prevent recurrence is the independent influencing factor for postoperative recurrence-free survival.

Key words: Carcinoma, hepatocellular, Neoplastic cells, circulating, Hepatectomy, Survival rate

Yunlong Cui, Qiang Li, Ti Zhang, Dalu Kong, Huikai Li, Qiang Wu, Tianqiang Song. Influencing factors for prognosis of patients with hepatocellular carcinoma complicated with portal vein tumor thrombus after surgical treatment[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(04): 249-253.

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References 22

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参数		例数	总体生存率（%）			χ ²值	P值	无复发生存在率（%）			χ ²值	P值
参数		例数	1年	2年	3年	χ ²值	P值	1年	2年	3年	χ ²值	P值
AFP（μg/L）		?	?	?	?	0.072	0.788	?	?	?	3.206	0.073
?	< 400	11	63.6	43.6	32.7	?	?	54.5	43.6	21.8	?	?
?	≥400	21	57.1	38.1	33.3	?	?	57.1	38.1	23.8	?	?
肿瘤数量		?	?	?	?	5.887	0.015	?	?	?	4.619	0.032
?	单发	27	66.7	47.9	39.9	?	?	40.7	21.6	13.0	?	?
?	多发	5	20.0	20.0	20.0	?	?	20.0	20.0	20.0	?	?
肿瘤直径（cm）		?	?	?	?	0.330	0.566	?	?	?	0.024	0.877
?	< 5	5	60.0	40.0	0.0	?	?	40.0	0	0	?	?
?	≥5	27	59.3	44.4	37.0	?	?	33.3	18.5	11.1	?	?
肿瘤包膜		?	?	?	?	1.126	0.289	?	?	?	2.355	0.125
?	有	1	-	-	-	?	?	-	-	-	?	?
?	无	31	61.3	41.7	31.3	?	?	35.5	15.5	7.7	?	?
卫星灶		?	?	?	?	1.534	0.215	?	?	?	0.093	0.761
?	有	19	63.2	47.4	42.1	?	?	36.8	21.1	10.5	?	?
?	无	13	53.8	28.8	19.2	?	?	30.8	15.4	15.4	?	?
微血管侵犯		?	?	?	?	0.014	0.907	?	?	?	0.360	0.548
?	有	28	60.7	42.6	34.8	?	?	35.7	17.1	8.6	?	?
?	无	4	50.0	25.0	25.0	?	?	25.0	25.0	25.0	?	?
肿瘤病理分级		?	?	?	?	1.657	0.647	?	?	?	3.545	0.315
?	高分化	2	100.0	100.0	50.0	?	?	50.0	50.0	50.0	?	?
?	中分化	14	64.3	42.9	42.9	?	?	42.9	21.4	14.3	?	?
?	中-低分化	11	45.5	24.2	24.2	?	?	27.3	0	0	?	?
?	低分化	5	40.0	20.0	20.0	?	?	20.0	20.0	20.0	?	?
癌栓分级		?	?	?	?	6.412	0.041	?	?	?	4.938	0.085
?	Ⅰ型	18	66.7	55.0	48.9	?	?	38.9	27.8	13.9	?	?
?	Ⅱ型	11	45.5	9.1	9.1	?	?	27.3	9.0	0	?	?
?	Ⅲ型	3	33.0	33.0	33.0	?	?	33.0	33.0	33.0	?	?
手术方式		?	?	?	?	6.315	0.044	?	?	?	3.566	0.059
?	肿瘤+癌栓整块切除	24	70.8	45.5	40.9	?	?	45.8	20.0	10.0	?	?
?	肿瘤切除+癌栓取出	8	25.0	25.0	12.5	?	?	12.5	12.5	12.5	?	?
复发后措施		?	?	?	?	14.913	0.000	?	?	?	-	-
?	有	18	72.0	55.6	38.9	?	?	-	-	-	?	?
?	无	10	20.0	0	0	?	?	-	-	-	?	?
预防复发措施		?	?	?	?	14.913	0.000	?	?	?	16.411	0.000
?	有	20	-	-	-	?	?	50.0	29.2	17.5	?	?
?	无	12	-	-	-	?	?	8.3	0	0	?	?

参数		例数	总体生存率（%）			χ ²值	P值	无复发生存在率（%）			χ ²值	P值
参数		例数	1年	2年	3年	χ ²值	P值	1年	2年	3年	χ ²值	P值
AFP（μg/L）		?	?	?	?	0.072	0.788	?	?	?	3.206	0.073
?	< 400	11	63.6	43.6	32.7	?	?	54.5	43.6	21.8	?	?
?	≥400	21	57.1	38.1	33.3	?	?	57.1	38.1	23.8	?	?
肿瘤数量		?	?	?	?	5.887	0.015	?	?	?	4.619	0.032
?	单发	27	66.7	47.9	39.9	?	?	40.7	21.6	13.0	?	?
?	多发	5	20.0	20.0	20.0	?	?	20.0	20.0	20.0	?	?
肿瘤直径（cm）		?	?	?	?	0.330	0.566	?	?	?	0.024	0.877
?	< 5	5	60.0	40.0	0.0	?	?	40.0	0	0	?	?
?	≥5	27	59.3	44.4	37.0	?	?	33.3	18.5	11.1	?	?
肿瘤包膜		?	?	?	?	1.126	0.289	?	?	?	2.355	0.125
?	有	1	-	-	-	?	?	-	-	-	?	?
?	无	31	61.3	41.7	31.3	?	?	35.5	15.5	7.7	?	?
卫星灶		?	?	?	?	1.534	0.215	?	?	?	0.093	0.761
?	有	19	63.2	47.4	42.1	?	?	36.8	21.1	10.5	?	?
?	无	13	53.8	28.8	19.2	?	?	30.8	15.4	15.4	?	?
微血管侵犯		?	?	?	?	0.014	0.907	?	?	?	0.360	0.548
?	有	28	60.7	42.6	34.8	?	?	35.7	17.1	8.6	?	?
?	无	4	50.0	25.0	25.0	?	?	25.0	25.0	25.0	?	?
肿瘤病理分级		?	?	?	?	1.657	0.647	?	?	?	3.545	0.315
?	高分化	2	100.0	100.0	50.0	?	?	50.0	50.0	50.0	?	?
?	中分化	14	64.3	42.9	42.9	?	?	42.9	21.4	14.3	?	?
?	中-低分化	11	45.5	24.2	24.2	?	?	27.3	0	0	?	?
?	低分化	5	40.0	20.0	20.0	?	?	20.0	20.0	20.0	?	?
癌栓分级		?	?	?	?	6.412	0.041	?	?	?	4.938	0.085
?	Ⅰ型	18	66.7	55.0	48.9	?	?	38.9	27.8	13.9	?	?
?	Ⅱ型	11	45.5	9.1	9.1	?	?	27.3	9.0	0	?	?
?	Ⅲ型	3	33.0	33.0	33.0	?	?	33.0	33.0	33.0	?	?
手术方式		?	?	?	?	6.315	0.044	?	?	?	3.566	0.059
?	肿瘤+癌栓整块切除	24	70.8	45.5	40.9	?	?	45.8	20.0	10.0	?	?
?	肿瘤切除+癌栓取出	8	25.0	25.0	12.5	?	?	12.5	12.5	12.5	?	?
复发后措施		?	?	?	?	14.913	0.000	?	?	?	-	-
?	有	18	72.0	55.6	38.9	?	?	-	-	-	?	?
?	无	10	20.0	0	0	?	?	-	-	-	?	?
预防复发措施		?	?	?	?	14.913	0.000	?	?	?	16.411	0.000
?	有	20	-	-	-	?	?	50.0	29.2	17.5	?	?
?	无	12	-	-	-	?	?	8.3	0	0	?	?

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