Extent of portal vein tumor thrombosis in patients with hepatocellular carcinoma: The more, the worse?

BACKGROUND&AIMS: Portal vein tumor thrombosis (PVTT) has a significant impact on the prognosis of patients with hepatocellular carcinoma (HCC). The degree of PVTT varies from sub-/segmental invasion to complete occlusion of the main trunk. Aim of this study was to evaluate whether the degree of PVTT correlates with prognosis.

METHODS: A total of 1317 patients with HCC treated at our tertiary referral center between January 2005 and December 2016 were included. PVTT was diagnosed by contrast-enhanced computed tomography or magnetic resonance imaging. The extent of PVTT was documented according to the Liver Cancer Study Group of Japan-classification: Vp0 = no PVTT, Vp1 = segmental portal vein invasion, Vp2 = right anterior/ posterior portal vein, Vp3 = right/ left portal vein, and Vp4 = main trunk. Median overall survival (OS) was calculated for each group.

RESULTS: PVTT was present in 484 (36.8%) patients. Median OS without PVTT was 35.7 months, significantly longer than in patients with PVTT (7.2 months, p<0.001). The patients with PVTT were subclassified as follows: 103 Vp1, 87 Vp2, 143 Vp3, and 151 Vp4. The corresponding median OS yielded 14.6, 9.4, 5.8, and 4.8 months for Vp1-Vp4, respectively (p<0.001).

CONCLUSIONS: PVTT in patients with HCC is associated with a dismal prognosis. The results indicate an association between the extent of PVTT and OS. However, the extent of PVTT is not that decisive, as even minor PVTT leads to a very poor prognosis. Therefore, meticulous evaluation of cross-sectional imaging is crucial for the clinical management of patients with HCC. This article is protected by copyright. All rights reserved.