肝细胞肝癌射频术后肝内复发情况及其影响因素分析

目的探讨肝细胞肝癌射频灭活后肝内复发情况及其影响因素。方法2001年3月至2006年8月共47例患者55个肿瘤接受射频治疗。患者肝功能Child—Pugh分级为A或B级，肿瘤直径小于5cm，病灶数目不超过3个。随访肿瘤多发情况，时间6～71个月，射频后的肝内复发分为肿瘤局部复发与肝内远处转移。分析因素包括患者全身情况（有无肝炎肝硬化、肝功能Chilcl-Pugh分级、血清甲胎蛋白水平）、肿瘤局部情况（大小、位置、数目）与治疗方法。采用Kaplan-Meier模型计算无瘤生存期，Log—rank检验进行单因素分析，Cox比例风险模型进行多因素分析。结果全组共25例患者出现肝内复发，其中8例肿瘤局部复发，14例肝内远处转移，3例同时合并局部及远处转移。射频术后1、2、3年肝内累计无瘤生存率分别为57．3％、40，3％、35．3％。单因素Log—rank检验显示肝内复发与肿瘤大小、位置与肝功能Child-Pugh分级相关。Cox比例风险模型显示肿瘤大小和肝功能Child—Pugh分级是影响肿瘤局部复发的危险因素，肿瘤数目是影响肝内远处转移的危险因素。结论选择肝功能Child-PughA级，直径≤3cm的单发肿瘤患者进行射频治疗，有助于提高疗效，降低术后肝内复发的风险。     

肝移植治疗原发性肝癌89例生存率分析

目的探讨肝移植治疗原发性肝癌（primary hepatic carcinoma,PHC）的术后生存率及其影响因素。方法回顾性分析2000年8月以来我院89例接受肝移植且随访时间≥6个月的PHC患者的临床资料。结果89例患者肝移植术后1、2和3年生存率分别为91．2％、68．5％、59．4％;单因素分析显示,肿瘤最大直径、门静脉癌栓、肿瘤分化程度和肿瘤TNM分期是影响生存率的重要因素,Cox风险模型多因素分析显示,肿瘤最大直径、肿瘤分化程度和肿瘤TNM分期是影响生存率的独立危险因素。结论肝移植是目前治疗PHC的有效方法,肿瘤直径〉5cm、肿瘤分化程度差和肿瘤TNM分期高均严重影响患者的生存率。     

血清GP73、AFP水平联合病理特征的肝癌术后预测复发模型的价值

目的探讨血清GP73、AFP水平联合病理特征的复发预测模型在评估肝癌术后中的价值。方法选取我院2014年2月至2016年8月肝胆外科就诊的肝癌术后患者90例,肝癌术后患者进行1年的随访,收集患者复发的情况,对患者血清GP73和AFP水平进行检测,通过运用Cox比例风险回归模型对影响患者术后复发的临床参数进行筛选,建立肝癌术后复发预测模型,并运用受试者工作特征曲线(ROC)评估该模型的预测价值。结果①患者6个月、12个月的复发率为22.2%、42.2%,血清GP73 70μg/L、AFP500 U/L、ALT42 U/L、肿瘤的数目≥3个、肿瘤的直径≥4 cm、低分化型、门静脉侵犯合并肝硬化均是肝癌术后复发的独立危险因素。②复发预测模型:预后指数(Prognostic index,PI):0.51×GP73+0.43×AFP+0.51×ALT-1.12×肿瘤数目(2)-1.02×肿瘤数目(1)+1.37×门静脉侵犯-0.73×分化(1)-0.86×分化(2)+0.75×合并肝硬化。预后术后复发的风险随着预后指数的增加不断升高。ROC曲线下面积(AUC)为0.76,预测复发的敏感度和特异度分别为54.7%、86.4%。结论血清GP73、AFP水平联合病理特征能较好的预测肝癌术后复发情况,具有重要的临床价值。     

乙型肝炎相关性肝癌患者肝切除术后肿瘤复发的相关因素调查

目的探讨乙肝相关性肝癌患者肝切除术后肿瘤复发的相关因素,为临床预防提供理论支持。方法选取我院2016年1月至12月收治的临床资料完整的102例乙肝相关性肝癌切除术患者为研究对象,随访2年。按照其是否复发分为复发组60例和未复发组42例。对可能导致患者复发的因素进行单因素及多因素logistic回归分析。结果复发组与未复发组在年龄、术前甲胎蛋白、肿瘤最大直径、包膜完整性、结节个数、门静脉肉眼癌栓、分化程度、微血管侵犯、解剖型肝切除、合并肝纤维化或肝硬化、术后抗病毒治疗依从性方面的差异有统计学意义(P0.05)。多因素logistic回归分析发现,术前甲胎蛋白、肿瘤最大直径、微血管侵犯、合并肝纤维化或肝硬化、术后抗病毒治疗依从性是导致患者术后复发的独立危险因素(P0.05)。结论乙肝相关性肝癌患者肝切除术后复发的风险较高,应该重视其危险因素,加强术后复诊和抗病毒治疗。     

门静脉癌栓及其治疗

门静脉癌栓（portal vein tumor thrombus,PVTT）是原发性肝癌的重要生物学行为,肝细胞癌（肝癌）易侵犯肝内结构,尤其是门静脉,比率为62．2％～90．2％。即使是肝癌早期,仍然在12．5％～39．7％之间。肝癌门静脉癌栓是导致肝癌患者肝内转移、术后复发的主要因素,其发展往往较快,多因肝功能衰竭或门脉高压症致上消化道静脉曲张破裂大出血死亡。     

老年可切除肝癌伴门静脉癌栓预后的影响因素分析

目的:探讨老年可切除肝癌伴门静脉癌栓预后的影响因素。方法:选择我院于2014年1月至2017年6月期间收治的老年可切除肝癌伴门静脉癌栓患者127例作为研究对象,均行肝癌根治性切除+门静脉切开取栓、门静脉癌切除、右半肝或者左半肝切除。所有患者出院后开始随访,以每6个月电话或者门诊随访其生存情况,至其死亡或随访至2018年8月。调查资料包括性别、分化程度、肿瘤直径、癌栓分型、合并肝硬化、甲胎蛋白、术后TACE、肝内转移、癌栓类型。结果:随访末,生存患者42例,死亡患者85例。两组患者在性别、分化程度、癌栓类型和甲胎蛋白方面比较无统计学差异(P0.05);死亡组低分化多于生存组,肿瘤直径≥8 cm多于生存组,合并肝硬化多于生存组,术后TACE多于生存组,有肝内转移多于生存组,浸润癌栓类型多于生存组,且有统计学差异(P0.05)。将上述单因素分析具有统计学差异的纳入多因素分析表明,低分化、肿瘤直径≥8cm、术后TACE、肝内转移和浸润型癌栓为影响肝癌伴门静脉癌栓预后独立危险因素。结论:老年可切除肝癌伴门静脉癌栓预后受多种因素影响,其中分化程度、肿瘤直径、术后TACE、肝内转移和癌栓类型为影响其预后独立危险因素。     

肝癌手术切除术后复发相关因素分析*

目的 研究影响肝癌患者手术后复发的相关因素,为临床预测患者术后复发提供指导。方法 回顾性分析我院2012年6月～2014年6月期间163例接受肝癌手术切除术患者的临床资料,随访并计算2年肿瘤复发和生存情况。收集所有患者的临床和病理学资料,应用SPSS 19.0统计学软件对相关资料进行处理,采用多因素Logistic回归分析影响肝癌患者术后复发的相关因素。结果 在随访的2年中,肿瘤复发51例,未复发112例;复发患者术前存在肝硬化 （80.39%）、肿瘤包膜不完整率（96.08%）、肝癌细胞分化为III和IV级比例（15.69%）、多发性肿瘤（49.02%）、多结节融合型的比例（64.71%）均明显高于未复发患者（P<0.01）;多因素Logistic回归分析显示,存在肝硬化、肿瘤包膜不完整、肿瘤细胞分化程度低、肿瘤数目多和肿瘤直径大均是导致肝癌患者术后复发的独立危险因素（P<0.05）。结论 肝癌患者术后复发是多种因素造成的,可能与肿瘤大小、有无肝硬化、包膜是否完整、肝癌细胞分化程度和肝癌数目等因素有关,可用于评估患者复发的危险性,对临床早期诊断及治疗具有重要的参考价值。     

颈动脉支架置入术后发生持续性低血压的危险因素分析

目的探讨颈动脉支架置入（CAS）术后发生持续性低血压的危险因素。方法选择行颈动脉颅外段支架置入术的患者105例。根据患者术后的血压状况，将其分为无低血压者、短暂性低血压者（收缩压〈90mmHg，或平均动脉压〈50mmHg，持续时间〈24h）及持续低血压者（上述低血压状态持续时间超过24h）。采用Cox多元回归法分析颈动脉支架置入术后发生持续性低血压的危险因素。结果105例患者中，术后29例（27．6％）出现短暂性低血压；16例（15．2％）出现持续低血压状态，其中3例低血压状态持续超过10d。16例持续低血压状态的患者持续时间为Md=3d（1～21d）。单因素分析发现，高龄（年龄〉75岁）、术前有低血压病史、狭窄程度≥80％、使用球囊后扩张、使用激光雕刻支架、操作时间超过1．5h与术后发生持续性低血压状态有关（P〈0．05）。经Cox比例风险分析并校正年龄和性别因素后，术前低血压病史（RR=4．53；95％CI1．39～9．72；P=0．008）、狭窄程度≥80％（RR=4．09；95％CI1．27～8．97；P=0．014）、使用球囊后扩张（RR=3．57；95％CI1．13～7．25；P=0．025）和操作时间〉1．5h（RR=4．87；95％C11．81～9．55；P=0．004）为术后发生持续性低血压的独立危险因素。结论术前有低血压病史、重度颈动脉狭窄、使用球囊后扩张和介入治疗操作时间较长的患者，术后更容易发生持续性低血压。     

术前血清 CEA 最佳预测值对早期肺癌患者术后的复发转移价值简

目的 探讨血清CEA最佳预测值对早期肺癌患者术后的复发转移价值.方法 收集在我院接受手术治疗并定期复查的早期肺癌,利用ROC曲线获得最佳CEA值,利用SPSS软件分析CEA在肺癌术后复发转移预测中的价值.结果 231 例Ⅰ期患者局部复发与远处转移47 例,复发转移率为20.3%（47/231）;整体人群的中位随访时间43.1月（9.5~97.2）月;其中腺癌181例,鳞癌50例.利用ROC曲线,腺癌患者中CEA取最佳预测值为2.47 ng/ml.患者术前CEA〉2.47 ng/ml与肿瘤低分化、最大径〉3 cm、脉管癌栓相关（P〈0.05）,术前CEA〉2.47 ng/ml是一个独立的危险复发转移因素（P=0.022）;鳞癌患者中CEA的最佳预测值为1.91 ng/ml,患者术前CEA〉1.91 ng/ml与年龄显著相关（P〈0.05）,术前CEA〉1.91 ng/ml是一个独立的危险复发转移因素（P=0.04）.结论 即使患者术前CEA值低于正常值（5 ng/ml）,术前CEA值在预测患者复发转移风险时也应考虑在内.     

肿瘤切除前TACE对巴塞罗那临床肝癌分期B期患者预后的影响

目的探讨肿瘤切除术前行经皮股动脉穿刺肝动脉化疗栓塞术（TACE）对巴塞罗那临床肝癌（BCLC）分期B期患者预后的影响。方法对309例首次行肝癌切除术的BCLC分期B期患者的临床资料进行回顾性分析,根据术前是否行TACE分为联合组和手术组,用两独立样本t检验和PearsonX2检验比较两组一般临床资料,用Log—rank检验和Cox比例风险回归模型比较两组生存率。结果两组一般临床资料无统计学差异（P〉0．05）;联合组和手术组中位生存期分别为36、26个月,组间比较P〈0．05（X2=9．226）;治疗方式、肿瘤直径、手术切缘和血清AFP水平是影响患者生存率的危险因素（P〈0．05）,且治疗方式是影响患者预后的独立危险因素（RR为1．576,95％CI为1．157—2．146,P=0．004）。结论对于BCLC分期B期患者,在切除术前给予辅助性TACE治疗有望延长术后生存时间。     

Application of cystoscope in surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus

Development of portal vein tumor thrombus deteriorates the prognosis of hepatocellular carcinoma, while surgical treatment can offer a promising prognosis for selected patients. However, the possibility of residual lesions in portal vein after conventional thrombectomy is a main risk factor leading to postoperative recurrence. Therefore, ensuring the complete removal of tumor thrombus during operation is critical to improve prognosis. For the first time, we report here one case of hepatocellular carcinoma with portal vein tumor thrombus in which cystoscope was successfully applied as a substitute of intravascular endoscope to visualize the cavity of the portal vein. The patient was a 61-year-old man with a 7-cm tumor in the right lobe of the liver, with tumor thrombus invading the right branch and adjacent to the conjunction of the portal vein. After removal of the tumor, the Olympus CYF-VA2 cystoscope was used to check the portal vein from the opening stump of the right branch of the portal vein. In this case, residual thrombus tissue was found near the opening stump and the conjunction of the portal vein. The residual lesion was carefully retrieved from the stump after retraction of the cystoscope. The procedure was repeated until no residual lesion was found. The whole duration time of thrombectomy was 22.5(15 + 7.5) min. The patient was free from recurrence at 8 months after the procedure. Our work indicated that the cystoscope is a suitable substitute, with a proper size and function to check the portal vein system and ensure the curability of thrombectomy. Although welldesigned clinic trails are still needed, this procedure may further improve the postoperative prognosis of hepatocellular carcinoma with portal vein tumor thrombus.     

门静脉免疫化疗对原发性肝癌切除术后患者预后的影响

目的观察门静脉免疫化疗对原发性肝癌切除后患者预后的影响。方法收集湖北医药学院附属太和医院2010年1月-2013年6月住院的48例手术切除并行术后门静脉免疫化疗患者,对其临床资料进行回顾性分析,并与同期未行门静脉免疫化疗的59例患者进行对比。计量资料的分析采用两样本资料的t检验,率的检验采用卡方检验。生存分析采用Kaplan-Meirer法计算平均生存时间,采用log-rank检验分析不同组之间的差异性。将107例患者合并,采用Cox回归模型分析对可能影响预后的因素进行多因素分析。结果免疫化疗组和对照组的1、2、3年的无瘤生存率分别为87.5%(42/48)和67.8%(40/59)(χ2=5.739,P=0.017)、52.1%(25/48)和32.2%(19/59)(χ2=4.320,P=0.038)、16.7%(8/48)和10.2%(6/59)(χ2=0.982,P=0.322),平均生存时间分别为(32.4±2.3)个月和(24.7±2.3)个月(χ2=4.044,P=0.044)。合并门静脉癌栓者术后行门静脉免疫化疗其平均生存时间(12.4±1.3)个月,而未行门静脉免疫化疗者为(4.8±0.4)个月(χ2=15.535,P0.001)。经Cox回归分析显示,肿瘤的分化程度、肿瘤的大小、肝功能分级、是否存在门静脉癌栓是影响肝细胞切除术后复发的独立危险因素,而是否采用门静脉免疫化疗对影响肝癌术后的复发时间有重要影响,具有统计学意义(P0.001)。结论门静脉免疫化疗可改善原发性肝癌切除后的无瘤生存率和生存时间。     

Clinicopathological risk factors and prognostic evaluation in hepatocellular carcinoma recurrence after surgery

AIM: To analyze the clinicopathological risk factors in hepatocellular carcinoma recurrence after surgery.METHODS: We used significance testing (χ² and Student’s t-test) of single and multiple factors, and Wilcoxon Cox tropic examination; a retrospective clinicopathological analysis was performed on 156 cases of hepatocellular carcinoma after hepatectomy.RESULTS: Of the 156 cases, 68.4%, 57.3%, 46.7%, 31.5%, and 28.6% had one, two, three, four, and five postoperative tumor-free years, respectively; the total recurrence rate was 53.2% (83/156). In the 83 recurrent cases, 65 were intrahepatic subclinical, with a resection rate of 78.3% (65/83). The relevant factors involved in recurrence were: male gender, tumor number and size, capsule infiltration, and portal vein involvement. These factors were an obvious influence on the prognosis of the patients with postoperative hepatocellular carcinoma (P < 0.05). In the recurrent liver carcinomas, 63.1% of tumor nodes (41/65) were at the ipsilateral segment of the primary tumor nodes.CONCLUSION: Male gender, tumor number and size, capsule infiltration, and portal vein involvement are factors for postoperative hepatocellular carcinoma recurrence. Recurrence is mainly unicentral. The right front liver lobe is the segment with a high rate of recurrence.     

Surgical treatment of hepatocellular carcinoma with direct removal of the tumor thrombus in the main portal vein.

BACKGROUND/AIMS: Hepatocellular carcinoma with tumor thrombus in the main portal vein is generally associated with a poor prognosis. If the liver function tolerated the hepatic resection, we aggressively selected surgical treatment. METHODOLOGY: We performed surgical treatment in 18 of 72 patients with hepatocellular carcinoma with tumor thrombus in the main portal vein. We analyzed the prognostic factors and survival rate of the surgical treatment group. RESULTS: The overall cumulative survival rates following the operation at 1 and 2 years were 48% and 34%, respectively. No patients died within 30 days of the operation. An univariate survival analysis revealed that intrahepatic metastases (P = 0.013), tumor differentiation (P = 0.011) and operative curability (P = 0.0058) had significant effects on survival. For the 6 patients with a complete resection, the cumulative survival rates at 1 and 2 years were 75% and 75%, respectively. In the 3 of 5 patients who died within 90 postoperative days, incomplete removal of the tumor thrombus in the portal vein or hepatic vein caused early recurrence and death. CONCLUSIONS: If the liver function tolerates the hepatic resection, hepatectomy of the main tumor combined with removal of tumor thrombus in the main portal vein is an effective treatment. This is especially true in patients where a long life is made possible by a complete resection of the main tumor, intrahepatic metastases and tumor thrombus. An important feature of this operation is to attempt complete removal of the tumor thrombus so as to prevent early recurrence and death.     

Spontaneous complete regression of hepatocellular carcinoma with portal vein tumor thrombus

We report herein a case of spontaneous complete regression of hepatocellular carcinoma with portal vein tumor thrombus. A 69-year-old Japanese man with chronic hepatitis C was admitted to our hospital, because of a large mass in the right hepatic lobe. He was diagnosed with hepatocellular carcinoma based on computed tomography and the elevated serum levels of alpha-fetoprotein. Abdominal angiography revealed portal vein tumor thrombus. Approximately 2 months after the initial diagnosis, alpha-fetoprotein had decreased to a normal range. Under a diagnosis of hepatocellular carcinoma, a right hepatic lobectomy was performed, and histological examination of the resected specimen revealed no viable tumor cells. The patient is alive 1 year after the surgery without evidence of recurrence.     

Factors influencing survival in hepatocellular carcinoma patients with macroscopic portal vein tumor thrombosis after surgery, with special reference to time dependency: a single-center experience of 381 cases

BACKGROUND/AIMS: The prognosis ofhepatocellular carcinoma with macroscopic portal vein tumor thrombosis is extremely poor. The risk factors may differ at different postoperative intervals. This study was undertaken to clarify the surgical outcome and time dependency of factors influencing survival in these patients. METHODOLOGY: We analyzed clinicopathological variables of 381 hepatocellular carcinoma patients with macroscopic portal vein tumor thrombosis who underwent hepatic resection. Survival rates were calculated using Kaplan-Meier method. The stratified Cox models were used to identify factors independently influencing short- and long-term survival, respectively. RESULTS: The cumulative 1-, 2-, 3-, 5-, and 10-year survival rates in 381 patients were 47%, 23%, 16%, 12%, 6%, respectively. The 1-, 3-, and 5-year survival rates calculated from time of re-resection were 36%, 14% and 0% in patients undergoing re-resection for intrahepatic recurrence within 2 years after first operation, and 85%, 53% and 32% in those more than 2 years after first operation (P<0.05). Multivariate analysis showed that portal vein infusion chemotherapy, serum alpha-fetoprotein > 20 mg/L and positive surgical margin were significant prognostic factors within 2 years after operation. In contrast, alanine aminotransferase > 80 U/L was the only significant factor beyond 2 years after operation. CONCLUSIONS: The survival of hepatocellular carcinoma patients with macroscopic portal vein tumor thrombosis was poor, but the prognosis of patients who had tumor recurrence more than 2 years after operation was much better than those with tumor recurrence within 2 years. Evaluation of time-dependency of risk factors may have important clinical implication in determining the therapeutic strategy.     

老年人肝细胞癌切除术后预后因素分析

目的 探讨老年肝细胞癌患者手术切除术后影响生存的因素.方法回顾性分析1995年1月至2002年12月连续手术切除的老年肝细胞癌患者54例,Kaplan Meier法统计术后生存期并进行单因素分析,Cox回归法进行多因素分析.结果Child-Pugh分级、脉管侵犯、卫星灶形成、病理学Edmondson-Steiner分级、肝内复发和远处转移影响老年肝细胞癌患者术后总体或无瘤生存（P＜0.05）.其中,Child-Pugh分级和脉管侵犯为术后总体生存的独立影响因素（相对危险度分别为3.37和2.73,P＜0.05）,而脉管侵犯独立影响无瘤生存（相对危险度为3.19,P＜0.05）.结论生物学行为和肝功能状况是影响老年人肝细胞癌预后的主要因素.     

The role of three-dimensional imaging in optimizing diagnosis,classification and surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus

Background

Accurate assessment of characteristics of tumor and portal vein tumor thrombus is crucial in the management of hepatocellular carcinoma.

Aims

Comparison of the three-dimensional imaging with multiple-slice computed tomography in the diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus.

Method

Patients eligible for surgical resection were divided into the three-dimensional imaging group or the multiple-slice computed tomography group according to the type of preoperative assessment. The clinical data were collected and compared.

Results

74 patients were enrolled into this study. The weighted κ values for comparison between the thrombus type based on preoperative evaluation and intraoperative findings were 0.87 for the three-dimensional reconstruction group (n = 31) and 0.78 for the control group (n = 43). Three-dimensional reconstruction was significantly associated with a higher rate of en-bloc resection of tumor and thrombus (P = 0.025). Using three-dimensional reconstruction, significant correlation existed between the predicted and actual volumes of the resected specimens (r = 0.82, P < 0.01), as well as the predicted and actual resection margins (r = 0.97, P < 0.01). Preoperative three-dimensional reconstruction significantly decreased tumor recurrence and tumor-related death, with hazard ratios of 0.49 (95% confidential interval, 0.27–0.90) and 0.41 (95% confidential interval, 0.21–0.78), respectively.

Conclusion

For hepatocellular carcinoma with portal vein tumor thrombus, three-dimensional imaging was efficient in facilitating surgical treatment and benefiting postoperative survivals.     

原发性肝癌门静脉侵犯MRI表现

目的手术前准确评价原发性肝癌(HCC)的门静脉瘤栓.方法 HCC 25例,门静脉瘤栓均经其它检查方法证实.磁共振为1.0T 超导系统.轴位扫描序列为 SE 序列 T1权重和 T2权重及 FLASH 序列.冠状扫描序列为 FLASH.结果门静脉瘤栓的信号强度和肿瘤一致.腔内门静脉瘤栓16例;6例为门静脉闭塞;3例为门静脉弥漫性狭窄.门静脉瘤栓MRI 表现为异常信号取代正常的门静脉流空,门静脉截断、门静脉不规则狭窄及侧支血管网形成.结论结合自旋回波和梯度回波扫描,MRI 评价门静脉瘤栓敏感性高,特征性强,而且无创伤性.     

Prognostic factors for hepatocellular carcinoma presenting with macroscopic portal vein tumor thrombus

BACKGROUND/AIMS: This study examines the prognostic factors including radiological findings of hepatocellular carcinoma presenting with macroscopic portal vein tumor thrombus. METHODOLOGY: From September 1992 to December 2002, 107 patients with hepatocellular carcinoma and a macroscopic portal vein tumor thrombus were treated at the National Cancer Center Hospital East. Patients' characteristics and diagnostic findings of computed tomography, angiography and computed tomography angiography were analyzed to determine the factors significantly related to the patients' prognosis. RESULTS: Enhanced portal vein tumor thrombus, main tumor occupying over 40% of the liver and distribution of tumors significantly affected survival. Cavernous transformation, thread and streak signs, arterio-portal shunt, extent of tumor thrombus, grade of venous invasion and tumor size did not affect survival. Clinical findings showed that Child-Pugh classification score over 7, etiology of hepatitis, total bilirubin over 2.2 mg/dL, prothrombin time under 50% and liver transaminases over 100 IU/L were poor prognostic factors. Multivariate analysis showed that AST over 100 IU/L, viral hepatitis and tumor occupying over 40% of the liver strongly affected the prognosis. CONCLUSIONS: Based on the present results, the most strongly affected prognostic factor was liver function as indicated by high level of transaminases. Various radiological findings did not affect survival. The elevation of transaminases seemed due to destruction of hepatocytes by growing tumor and circulatory disruption due to portal vein tumor thrombus. We concluded that radiological findings of hepatocellular carcinoma presenting with portal vein tumor thrombus indicated only intrahepatic status but not survival. First treatment for hepatocellular carcinoma presenting with portal vein tumor thrombus should be to improve the liver function. Treatment against hepatitis virus might be important and patients with AST over 100 IU/L and a tumor occupying over 40% should not undergo surgical resection.