Introduction: Hepatocellular carcinoma (HCC) had a high incidence of portal vein tumor thrombus (PVTT), and the occurrence of PVTT usually indicated a poor prognosis. In recent years, liver transplantation has been recommended as an alternative treatment for HCC with PVTT, however the efficacy is still controversial. Preoperative adjuvant therapy had a certain effect in hepatectomy for HCC with PVTT, but its role in liver transplantation has not been reported. Therefore, the purpose of this study is to explore the effect of preoperative adjuvant therapy on the efficacy of HCC with PVTT after liver transplantation.
Methods: The clinical data of 22 patients with hepatocellular carcinoma with portal vein tumor thrombus (HCC + PVTT) undergoing liver transplantation from one center from 2010 to 2017 were analyzed retrospectively. 22 patients with hepatocellular carcinoma without portal vein tumor thrombus (HCC) were matched according to their age, tumor size and tumor number. The overall survival(OS) rate and recurrence-free survival(RFS) rate were compared between the two groups. At the same time, the OS and RFS of 22 patients with HCC+PVTT undergoing liver transplantation with preoperative adjuvant therapy and without preoperative adjuvant therapy were compared. Univariate and multivariate Cox regression analysis were used to explore the independent risk factors of recurrence.
Results: The 1- and 3-year OS in HCC + PVTT group were 63.64% and 30.69%, respectively, which were significantly lower than HCC group (81.57% and 52.78%, P = 0.0391, respectively). The 1- and 3-year RFS in HCC + PVTT group were 51.71% and 40.22%, respectively, which were significantly lower than HCC group (74.46% and 68.73%, P = 0.0407). In HCC + PVTT group, the 1- and 3-year OS in preoperative adjuvant therapy group were 70% and 40%, respectively, higher than non preoperative adjuvant therapy group (58.33% and 16.67%, P = 0.179), and the 1- and 3-year RFS in preoperative adjuvant therapy group were 88.89% and 63.49%, respectively, which were significantly higher than non preoperative adjuvant therapy group (20.37% and 20.37%, P = 0.0336). Univariate and multivariate Cox regression analysis showed that preoperative adjuvant therapy was an independent factor affecting recurrence after liver transplantation in HCC + PVTT group (P = 0.010 and P = 0.023).
Conclusion: This study was the first to explore the effect of preoperative adjuvant therapy on the efficacy of hepatocellular carcinoma with portal vein tumor thrombus after liver transplantation. In this study, the prognosis of patients with HCC + PVTT was poor. Preoperative adjuvant therapy can improve the prognosis of HCC + PVTT patients after liver transplantation and reduce the risk of recurrence. This study had certain clinical significance for exploring the preoperative treatment and operation timing of HCC with PVTT for liver transplantation. However, due to the small sample size of this study, which still need to be further verified by multi center large sample size research.