OBJECTIVETo compare the clinical effects of different therapies on hepatocellular carcinoma (HCC) with portal vein tumor thrombi (PVTT), and to study the factors that affected the prognosis.

METHODSOne hundred and thirty eight HCC with PVTT patients, whose liver function was compensatory and both tumor and PVTT could probably be resected together as evaluated by preoperative examinations, were divided into four groups: 1. conservative treatment group (n = 14); 2. chemotherapy group (n = 41); 3. surgical resection group (n = 19); 4. surgical resection with postoperative chemotherapy group (n = 64).

RESULTSThe median survival periods in four groups were 3.5, 7.1, 10.1 and 13.4 months, respectively. The half a year-, 1-, 2-, 3-year survival rates in the surgical resection with postoperative chemotherapy group were 53.7%, 37.6%, 30.7% and 14.0%, respectively, which were significantly higher than those of the other three groups (P < 0.05). Univariate and multivariate analysis both revealed that the number of chemotherapy courses affected the effect of surgical resection.

CONCLUSIONS1. If patients' liver function is compensatory and tumors with PVTT can be removed together, exploration should be done. Surgical resection followed by postoperative chemotherapy would produce the best clinical result. 2. If patients' liver function is permissible, multiple chemotherapeutic courses should be given after resection of HCC with PVTT.