OBJECTIVETo evaluate the efficacy of surgical treatment combined with immunochemotherapy via portal vein for hepatocellular carcinoma (HCC) with major portal vein tumor thrombus (PVTT).

METHODSBetween January 2001 and December 2005 76 HCC patients with tumor thrombus in portal trunk and (or) the first-order branch were recruited into the study. Patients were divided into group A (n = 29) and B (n = 47). Patients in group A were treated with hepatectomy plus portal thrombectomy in combination with postoperative adjuvant immunochemotherapy administered via portal vein. The immunochemotherapy regimen consisted of 5-Fluorouracil, Adriamycin, platinol and alpha-Interferon (PIAF). Patients in group B were subjected to hepatectomy plus thrombectomy alone. Survival rates were compared between two groups, and prognostic factors were identified.

RESULTSHalf-, One-, two- and three-year cumulative survival rates were markedly greater in group A than group B, being 82.3% vs 52.7%, 46.5% vs 20.2%, 14.3% vs 5.8%, 14.3% vs 5.8%, respectively. Group A had a significantly longer median survival time and median tumor-free survival time as compared with group B, being 11.5 months vs 6.0 months (P = 0.010), 4.5 months vs 2.4 months (P = 0.032), respectively. Multivariate analysis revealed that immunochemotherapy, pathological grading and tumor size were independent factors for survival times. And immunochemotherapy and pathological grading were independent factors for tumor-free survival time.

CONCLUSIONSSurgical resection combined with adjuvant immunochemotherapy via portal vein represents as an effective modality for HCC with PVTT.