A study of the clinical profile, predictors, prognostic features, and survival of patients with hepatocellular carcinoma having macroscopic portal vein tumor thrombosis

Background Macroscopic portal vein tumor thrombosis (PVTT) is considered a negative prognostic factor in hepatocellular carcinoma (HCC) patients. There is divergent opinion regarding management of these patients worldwide. We aimed to evaluate the clinical profile, predictors, prognostic features, and survival of patients of HCC with PVTT. Methods Treatment-naïve HCC patients with and without PVTT were analyzed retrospectively using a prospectively accrued dataset. Patients with PVTT were further divided as per treatment groups for survival analysis. Results Of 508 patients, 46.1% had radiological evidence of PVTT at presentation. On logistic regression, serum albumin (odds ratio [OR]=0.65, 95% confidence interval [CI]= 0.44–0.96; p = 0.031); international normalized ratio (OR = 3.78,95% CI = 1.42–10.00; p =0.008); alpha-feto protein >400 ng/mL (OR=3.58, 95%CI = 2.00–6.40; p <0.001); size of largest tumor nodule >5 cm (OR =6.37, 95%CI =2.03–19.99; p =0.002); and male gender (OR =1.84, 95%CI = 1.01–3.33; p = 0.045) were independent predictors for PVTT. Patients with PVTT amenable to aggressive therapies had significantly better median overall survival (in months) as compared to those receiving sorafenib or best supportive care only (13.1, 3.9, and 1.8 respectively, p <0.0001). Treatment modality received ( p <0.001) and extrahepatic metastasis ( p =0.006) were independent predictors of mortality in these patients. Conclusion Size of largest tumor nodule >5 cm and alpha-fetoprotein >400 ng/mL are strongly associated with the presence of PVTT in patients with HCC. A multidisciplinary approach may identify a subgroup of patients who can be offered aggressive therapies like surgery and/or locoregional therapy with significant survival benefit.