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. 2024 Mar;24(1):102-112.
doi: 10.17998/jlc.2024.01.31. Epub 2024 Feb 14.

Liver resection in selective hepatocellular carcinoma with Vp3 or Vp4 portal vein tumor thrombosis improves prognosis

Manuel Lim  1 , Jongman Kim  2 , Jinsoo Rhu  2 , Gyu-Seong Choi  2 , Jae-Won Joh  2
Affiliations

Liver resection in selective hepatocellular carcinoma with Vp3 or Vp4 portal vein tumor thrombosis improves prognosis

Manuel Lim et al. J Liver Cancer. 2024 Mar.

Abstract

Background/aim: Hepatocellular carcinoma (HCC) tumor thrombi located in the first branch of the portal vein (Vp3) or in the main portal trunk (Vp4) are associated with poor prognosis. This study aimed to investigate the clinicopathological characteristics and risk factors for HCC recurrence and mortality following liver resection (LR) in patients with Vp3 or Vp4 HCC.

Methods: The study included 64 patients who underwent LR for HCC with Vp3 or Vp4 portal vein tumor thrombosis (PVTT).

Results: Fifty-eight patients (90.6%) had Vp3 PVTT, whereas the remaining six patients exhibited Vp4 PVTT. The median tumor size measured 8 cm, with approximately 36% of patients presented with multiple tumors. Fifty-four patients (84.4%) underwent open LR, whereas 10 patients underwent laparoscopic LR. In the Vp4 cases, combined LR and tumor thrombectomy were performed. The 3-year cumulative disease-free survival rate was 42.8% for the Vp3 group and 22.2% for the Vp4 group. The overall survival (OS) rate at 3 years was 47.9% for the Vp3 group and 60.0% for the Vp4 group. Intrahepatic metastasis has been identified as an important contributor to HCC recurrence. High hemoglobin levels are associated with high mortality.

Conclusion: LR is a safe and effective treatment modality for selected patients with Vp3 or Vp4 HCC PVTT. This suggests that LR is a viable option for these patients, with favorable outcomes in terms of OS.

Keywords: Mortality; Neoadjuvant therapy; Recurrence; Survival.

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Conflict of interest statement

Conflict of Interest

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
(A) Disease-free survival and (B) overall survival in Vp3 and Vp4. HCC, hepatocellular carcinoma.
Figure 2.
Figure 2.
(A) Overall survival following TACE-based locoregional therapies before liver resection and (B) overall survival following combination therapies with TACE and external beam radiation therapy (EBRT) before liver resection. TACE, transarterial chemoembolization; LRT, locoregional therapy; RT, radiation therapy.
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