Liver resection for hepatocellular carcinoma associated with hepatic vein invasion: A Japanese nationwide survey.

371 Background: Because of the rarity of hepatic vein tumor thrombus (HVTT), compared with portal vein tumor thrombus (PVTT), in patients with hepatocellular carcinoma (HCC), little is known about this disease entity. The aim of this study was to evaluate the prognosis of each treatment modality for HVTT through an analysis of data collected in a Japanese nationwide survey. Methods: We analyzed data for 1,021 Child-Pugh A HCC patients with HVTT without inferior vena cava invasion registered between 2000 and 2007. Of these patients, 540 patients who underwent liver resection (LR) and 481 patients who received other treatments were compared. The propensity scores were calculated and we successfully matched 244 patients (52.5% of the LR group). Results: The median survival time (MST) in the LR group was 2.89 years longer than that in the non-LR group (4.47 years vs 1.58 years; P < 0.001) and 1.17 years longer than that in the non-LR group (2.93 years vs 1.76 years; P = 0.009) in a propensity score-matched cohort. After curative resection, the MSTs were similar between patients with HVTT in the peripheral hepatic vein and those with HVTT in the major hepatic vein (4.85 years vs 4.67 years; P = 0.974). In the LR group, the postoperative 90-day mortality rate was 3.4% (16patients). In patients without PVTT, the MST was significantly better than that in patients with PVTT (5.67 years vs. 1.88 years; P < 0.001). Conclusions: LR is associated with a good prognosis in HCC patients with HVTT, especially in patients without PVTT.