An EHBH‐PVTT scoring system as an aid to decision‐making on hepatectomy for HCC patients with PVTT: a multicenter study

Abstract

Background

Portal vein tumour thrombus (PVTT) is a significant poor prognostic factor for hepatocellular carcinoma (HCC). Patients with PVTT limited to a first‐order branch of the main portal vein (MPV) or above could benefit from R0 liver resection (LR). An EHBH‐PVTT scoring system was established to predict the prognosis of HCC patients with PVTT after R0 LR, and to guide selection of subgroups of patients that could benefit from LR.

Methods

HCC patients with PVTT limited to a first‐order branch of the MPV or above who underwent R0 LR as an initial therapy were included. The EHBH‐PVTT score was developed from a retrospective cohort in the training cohort using a Cox‐regression model and validated in a prospective internal validation cohort and three external validation cohorts.

Results

There were 432 patients in the training cohort, 285 in the prospective internal validation cohort, and 286, 189 and 135 in 3 external validation cohorts, respectively. The score was conducted using total bilirubin, α‐fetoprotein, tumour diameter and satellite lesions. The EHBH‐PVTT score differentiated two groups of patients (≤/>3 points) with distinct long‐term prognoses (median OS, 17.0 vs 7.9 months; P<0.001). The predictive accuracy, as determined by the area under the time‐dependent receiver operating characteristic curves (AUC, 0.680 to 0.721), was greater than that of the other commonly used staging systems for HCC and PVTT.

Conclusion

The EHBH‐PVTT scoring system was more accurate in predicting the prognosis of HCC patients with PVTT than other staging systems after LR. It selected appropriate HCC patients with PVTT limited to a first‐order branch of the MPV or above for LR. It can be used to supplement the other HCC staging systems.

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