Asahara T, Itamoto T, Katayama K, Nakahara H, Hino H, Yano M, Ono E, Dohi K, Nakanishi T, Kitamoto M, Azuma K, Itoh K, Shimamoto F
Second Department of Surgery, Hiroshima University Hospital, Japan.
Hepatogastroenterology. 1999 May-Jun;46(27):1862-9.
BACKGROUND/AIMS: It is still controversial whether surgical or non-surgical treatments should be adopted for hepatocellular carcinomas (HCC) with tumor thrombi (TT) in the major vasculatures. We evaluate the effectiveness of and the indications for hepatic resection with tumor thrombectomy for such patients.
Seventeen patients with TT in the major vasculatures caused by HCC were enrolled. Eleven patients had Vp3 TT, 5 patients had Vv3 TT, and 1 patient had Vp3 and Vv3 TT, concurrently. Out of the 17 patients, 13 underwent hepatic resections with tumor thrombectomies and the remaining 4 received only hepatic resections without tumor thrombectomies.
In patients with Vp3 TT, median and mean survival times were 7.8 and 18.5 months, respectively, and 1- and 5-year survival rates were 36.4% and 18.2%, respectively. In patients with Vv3 TT, median and mean survival times were 9.9 and 8.4 months, respectively. Patients who underwent hepatic resections with tumor thrombectomies had significantly better prognoses than those who did not receive tumor thrombectomies (p=0.0039).
The prognosis of HCC patients with TT in the major vasculatures, who have relatively small primary tumors, good hepatic functional reserves and no distant metastases should be good, if hepatic resections with tumor thrombectomies are performed.
背景/目的：对于主要脉管系统内有瘤栓（TT）的肝细胞癌（HCC）患者，应采用手术还是非手术治疗仍存在争议。我们评估此类患者行肝切除联合肿瘤血栓清除术的有效性及适应证。
纳入17例由HCC导致主要脉管系统出现TT的患者。11例患者为Vp3 TT，5例患者为Vv3 TT，1例患者同时存在Vp3和Vv3 TT。17例患者中，13例行肝切除联合肿瘤血栓清除术，其余4例仅行肝切除未行肿瘤血栓清除术。
Vp3 TT患者的中位生存时间和平均生存时间分别为7.8个月和18.5个月，1年和5年生存率分别为36.4%和18.2%。Vv3 TT患者的中位生存时间和平均生存时间分别为9.9个月和8.4个月。行肝切除联合肿瘤血栓清除术的患者预后明显优于未行肿瘤血栓清除术的患者（p = 0.0039）。
对于主要脉管系统内有TT、原发肿瘤相对较小、肝功能储备良好且无远处转移的HCC患者，如果行肝切除联合肿瘤血栓清除术，预后应该较好。
