本研究旨在调查与门静脉肿瘤血栓（PVTT）相关的原发性肝细胞癌（HCC）复发和生存的预后因素。在韩国首尔阿山医疗中心，回顾性研究了161例2003年1月至2014年1月接受肝切除术的HCC合并症PVTT的患者。进行回归分析以识别有利的预测因素，用于整体生存（OS）和无复发生存（RFS）。中位随访时间为15.9个月，其中1、3和5年的OS分别为65.0％、38.4％和36.0％，1年的RFS为25.5％。Vp 1-2和Vp3-4 PVTT患者的OS和RFS没有显着差异。肝内复发患者的整体生存显着优于肝外复发患者。经导管经动脉化学栓塞和射频消融是肝内转移最有效的治疗方法，而手术是肝外转移最有效的治疗方法。在多元分析中，食管静脉曲张的缺失，最大肿瘤大小<5厘米，单叶叶区的肿瘤位置和解剖学切除是OS和R0切除的有利预测因素，微血管浸润的缺失是RFS的有利预测因素。考虑到有利的预后因素，包括食管静脉曲张的缺失，最大肿瘤大小<5厘米，单叶叶区的肿瘤位置和解剖学切除，R0切除和微血管浸润的缺失，可以改善HCC合并PVTT患者长期的结果。此外，复发性HCC需要积极治疗以延长整体生存。© 2023.外科肿瘤学学会。

This study aimed to investigate prognostic factors of recurrence and survival associated with hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT).This retrospective study included 161 patients with HCC with PVTT who underwent hepatectomy between January 2003 and January 2014 at the Asan Medical Center. Regression analyses were conducted to identify favorable predictive factors for overall survival (OS) and recurrence-free survival (RFS).The median follow-up was 15.9 months, while 1-, 3-, and 5-year OS was 65.0%, 38.4%, and 36.0%, respectively, and 1-year RFS was 25.5%. There were no significant differences in OS and RFS between the patients with portal vein invasion (Vp) 1-2 and Vp3-4 PVTT. Patients with intrahepatic recurrence had significantly better overall survival than patients with extrahepatic recurrence. Transcatheter arterial chemoembolization and radiofrequency ablation were the most effective treatments for intrahepatic metastasis, and surgery was the most effective treatment for extrahepatic metastasis. On multivariate analysis, absence of esophageal varices, maximal tumor size < 5 cm, tumor location in single lobe, and anatomical resection were favorable prognostic factors for OS and R0 resection, and absence of microvascular invasion was a favorable prognostic factor for RFS.The long-term outcome of patients with HCC with PVTT can be improved under consideration of favorable prognostic factors including absence of esophageal varices, maximal tumor size < 5 cm, tumor location in single lobe, and anatomical resection, R0 resection, and absence of microvascular invasion. In addition, recurrent HCC required aggressive management to prolong overall survival.© 2023. Society of Surgical Oncology.