The prognosis of advanced hepatocellular carcinoma remains poor, particularly in patients with tumor thrombi in the major vessels.
Dr Naoto Gotohda and colleagues assessed 161 patients as having advanced hepatocellular carcinoma with major vascular involvement.
Among these patients, 20% underwent surgical resection.
The research team reported that 11% received radiotherapy.
A further 45% underwent transcatheter arterial chemoembolization or transcatheter arterial infusion chemotherapy.
There were 5% with distant metastases who received systemic chemotherapy, and 19% received palliative therapy.
|Prothrombin activity more than 78% achieved a similar survival to those with complete resection|
|World Journal of Surgery|
Excluding the complete resection group, the patients in the reductive resection group had a higher 1-year survival rate than the other treatment groups.
However, there was no significant difference in the overall survival rates of the reductive resection, radiotherapy, and transcatheter arterial chemoembolization or transcatheter arterial infusion chemotherapy groups.
The investigative team evaluated prognostic factors to clarify the indications for reductive resection with advanced hepatocellular carcinoma with tumor thrombi.
The investigators identified that prothrombin activity as a significant independent preoperative factor for overall survival in the reductive resection group.
The survival rate in patients with prothrombin activity of 78% or less was lower than that of patients with prothrombin activity of more than 78%.
The median survival time of patients with serum prothrombin activity of more than 78% who underwent reductive resection was 14 months.
The team observed that in patients who underwent complete resection, the median survival time was 9 months, with no survival difference between the groups.
Dr Gotohda's team concluded, “In advanced hepatocellular carcinoma with major vascular involvement, patients who had reductive resection with prothrombin activity of greater 78% achieved a similar survival to those who had complete resection.”
“The surgeon should still proceed with reductive resection in those patients with serum prothrombin activity of more than 78% if complete resection does not seem feasible on preoperative evaluation.”