Prognostic index for portal vein tumor thrombosis in patients with hepatocellular carcinoma treated with radiation therapy

Abstract

We performed a retrospective review of 281 hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) treated with radiation therapy (RT) between 1998 and 2008 to develop a prognostic model for those patients. Of the 281 patients, PVTT and intrahepatic main masses completely disappeared in 10 patients (3.6%), and shown a partial response in 141 patients (50.2%). The median survival was 11.6 months. Patients who had more than PR have shown significantly longer survival than the others (22.0 months vs 5.0 months, P < 0.001). On the multivariate analysis, pre-treatment poor prognosticators for overall survival were ECOG performance status, Child-Pugh class, multiple tumors, main PVTT, complete portal vein occlusion, lymph node metastasis, and primary tumor size. Prognostic index of RT for PVTT of HCC (PITH) scores were defined as the number of pre-treatment poor prognostic factors. PITH scores correlated well with overall survival. In the analysis of 1 and 2 yr overall survival rate, patients who had PITH scores of 3 or greater showed a significantly lower rate of overall survival than the others (33.0%, 17.3% vs 70.1%, 40.8%, respectively, P < 0.001). The PITH scoring model, proposed in the current study in HCC patients with PVTT, reliably predict overall survival.

Keywords: Carcinoma, Hepatocellular; Portal Vein Tumor Thrombosis; Prognostic Index; Radiotherapy.

Fig. 1

Overall survival and portal vein tumor thrombosis progression free survival of all patients: Kaplan-Meier curves for overall survival (A) and portal vein tumor thrombosis (PVTT) progression free survival (B) rate of all patients with hepatocellular carcinoma (HCC) and PVTT treated with radiation therapy (RT).

Fig. 2

Overall survival according to the RT response: Kaplan-Meier curves for overall survival rate according to the RT response.

Fig. 3

Overall survival according to PITH scoring (A, all groups; B, 4 groups; C, 2 groups): Kaplan-Meier curves for overall survival rate according to PITH scoring. PITH score was calculated by the number of prognostic factors; ECOG performance status (≥ 2), Child-Pugh class (B or C), multiple tumor (more than 2), main PVTT, complete portal vein occlusion, lymph node metastasis, and primary tumor size (≥ 10 cm). PITH scores correlated well with OS (A). Patients were divided into four groups (B) and two groups (C) for statistical analyses.