Significance of trans-hepatic arterial chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombus.

Portal vein tumor thrombus (PVTT) is observed in a considerable number of hepatocellular carcinoma (HCC) cases. It is an exacerbating factor for patients afflicted with HCC. The sequelae of PVTT are considered to be a contraindication for the treatment of HCC in such patients. The survival of 10 HCC patients with PVTT treated with trans-hepatic arterial continuous injection chemotherapy was compared to 13 HCC patients with PVTT, who received best supportive care only, as a control to validate the efficacy of continuous trans-hepatic arterial injection chemotherapy using an implanted catheter for HCC with PVTT. There were no differences in the liver function and HCC stage between the two groups. The survival was significantly different between the two groups (P=0.01 by the log-rank test). The median survival time was 106 days in the treatment patients, whereas it was 65 days in the control patients. Multivariate analyses showed the therapy to be the only predictor for survival (risk ratio 0.144, P=0.016). The therapy was strongly associated with the PVTT prognosis. In conclusion, the importance of trans-arterial chemotherapy was demonstrated even in advanced dysfunctional cirrhotic HCC patients with PVTT. It is therefore necessary to develop a basic protocol to treat HCC with PVTT.