Prognostic factors for survival in hepatocellular carcinoma with portal vein tumor thrombus: a single-center retrospective study

Abstract:

Background and Aims Hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) is associated with extremely poor prognosis. Identification of prognostic factors is essential for clinical decision-making. This study aimed to investigate survival-related prognostic factors in HCC patients with PVTT based on real-world data.Methods A total of 195 patients with HCC and PVTT admitted to the First Affiliated Hospital of Nanchang University between January 2019 and December 2021 were retrospectively enrolled and followed up until December 2022. Survival analysis was performed using the Kaplan-Meier method. Univariate analysis was conducted using the Log-rank test, and multivariate analysis was performed using the Cox proportional hazards model.Results During follow-up, 162 patients (83.08%) died. The median survival time was 114 (102-126) d. The 30-, 90-, 180-d, and 1-, 2-, and 3-year survival rates were 82.56%, 56.41%, 38.97%, 26.67%, 18.46%, and 16.92%, respectively. Univariate analysis identified age, performance status (PS), albumin, total bilirubin (TBIL), and lymphocyte count as significant prognostic factors (all P<0.05). Multivariate analysis revealed that PS>2, lymphocyte count <1.7×10⁹/L, and TBIL>26 μmol/L were independent predictors of poor prognosis (all P<0.05).Conclusion Patients with HCC and PVTT have poor overall survival. Elevated PS score, lymphopenia, and increased bilirubin levels are independent adverse prognostic factors, which may serve as useful indicators for risk stratification and individualized treatment.