Fukuda Shuichi, Okuda Koji, Imamura Mahiro, Imamura Ichiro, Eriguchi Naofumi, Aoyagi Shigeaki
Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan.
Surgery. 2002 Mar;131(3):300-10. doi: 10.1067/msy.2002.120668.
Prognosis of hepatocellular carcinoma (HCC) with tumor thrombus in the main portal vein (MPV), inferior vena cava (IVC), or extrahepatic bile duct (EBD) treated by conventional therapies has been considered poor. This study aimed to evaluate the efficacy of hepatic arterial infusion chemotherapy after surgical resection as an adjuvant therapy or as a treatment for intrahepatic recurrence of HCC with tumor thrombus in MPV, IVC, or EBD.
Nineteen patients with HCC and tumor thrombus in the MPV, IVC, or EBD who underwent hepatectomy with thrombectomy were reviewed retrospectively.
The overall 3-year survival rate was 48.5%. Two patients with postoperative residual tumor thrombus died within 6 months owing to rapid progression of the residual tumor thrombus. Five patients survived more than 5 years after their operations. Tumors disappeared completely in 3 patients after hepatic arterial infusion chemotherapy with a combination of cisplatinum and 5-fluorouracil, and the longest survival period was 17 years and 11 months in a patient with EBD thrombus.
If hepatic reserve is satisfactory, an aggressive surgical approach combined with chemotherapy seems to be of benefit for patients having HCC with tumor thrombus in the MPV, IVC, or EBD.
肝细胞癌（HCC）伴有主门静脉（MPV）、下腔静脉（IVC）或肝外胆管（EBD）肿瘤血栓，采用传统疗法治疗的预后一直被认为较差。本研究旨在评估手术切除后肝动脉灌注化疗作为辅助治疗或作为MPV、IVC或EBD中伴有肿瘤血栓的HCC肝内复发的治疗方法的疗效。
回顾性分析19例伴有MPV、IVC或EBD肿瘤血栓的HCC患者，这些患者接受了肝切除及血栓清除术。
总体3年生存率为48.5%。2例术后残留肿瘤血栓的患者因残留肿瘤血栓迅速进展在6个月内死亡。5例患者术后存活超过5年。3例患者在接受顺铂和5-氟尿嘧啶联合肝动脉灌注化疗后肿瘤完全消失，1例伴有EBD血栓的患者最长生存期为17年11个月。
如果肝储备良好，积极的手术方法联合化疗似乎对伴有MPV、IVC或EBD肿瘤血栓的HCC患者有益。
