Matsuda Masanori, Suzuki Tetsuya, Kono Hiroshi, Fujii Hideki
First Department of Surgery, Yamanashi University School of Medicine, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan.
J Hepatobiliary Pancreat Surg. 2007;14(3):289-96. doi: 10.1007/s00534-006-1142-0. Epub 2007 May 29.
In this study, we tried to identify the preoperative predictors of hepatic venous trunk invasion and the prognostic factors in patients with hepatocellular carcinoma (HCC) that had come into contact with the trunk of a major hepatic vein over a distance of 1.0 cm or more.
Forty patients who had such HCCs resected were entered into this study and predictors of hepatic venous trunk invasion and prognostic factors were evaluated by univariate and multivariate analyses.
A combined resection of the HCC and the venous trunk was performed in 29 patients. Hepatic venous trunk invasion was observed in 12 patients, including 2 with inferior vena cava tumor thrombus. A stepwise logistic regression analysis indicated that tumors larger than or equal to 7 cm in diameter and tumors showing a poorly differentiated histological grade were independent predictors of hepatic venous trunk invasion. The survival of patients without venous trunk invasion was significantly better than that for patients with venous trunk invasion (P = 0.048). A univariate analysis revealed that Child-Pugh classification B (P = 0.002), a high des-gamma-carboxy prothrombin concentration (> or =400 mAU/ml, P = 0.023), a large HCC (> or =5.0 cm in diameter, P = 0.002), the presence of portal vein invasion (P < 0.001), the presence of venous trunk invasion (P = 0.048), the presence of intrahepatic metastasis (P < 0.001), and poorly differentiated HCC (P = 0.006) correlated with a worse overall survival after hepatic resection. In a multivariate analysis, however, only the presence of intrahepatic metastasis (P = 0.037, relative risk 8.25) was an independent predictor of poor overall survival.
Large tumors (> or =7 cm in diameter) and poorly differentiated HCCs were more likely to be associated with hepatic venous trunk invasion and intrahepatic metastasis was an independent prognostic factor in patients with HCC that had come into contact with the trunk of a major hepatic vein.
在本研究中，我们试图确定肝静脉主干侵犯的术前预测因素以及与主要肝静脉主干接触距离达1.0厘米或以上的肝细胞癌（HCC）患者的预后因素。
40例接受此类HCC切除术的患者纳入本研究，通过单因素和多因素分析评估肝静脉主干侵犯的预测因素和预后因素。
29例患者行HCC与静脉主干联合切除术。12例患者观察到肝静脉主干侵犯，其中2例伴有下腔静脉瘤栓。逐步逻辑回归分析表明，直径大于或等于7厘米的肿瘤以及组织学分级为低分化的肿瘤是肝静脉主干侵犯的独立预测因素。无静脉主干侵犯患者的生存率显著高于有静脉主干侵犯的患者（P = 0.048）。单因素分析显示，Child-Pugh B级（P = 0.002）、高去γ-羧基凝血酶原浓度（≥400 mAU/ml, P = 0.023）、大肝癌（直径≥5.0厘米, P = 0.002）、门静脉侵犯（P < 0.001）、静脉主干侵犯（P = 0.048）、肝内转移（P < 0.001）以及低分化HCC（P = 0.006）与肝切除术后较差的总生存率相关。然而，多因素分析显示，只有肝内转移（P = 0.037，相对危险度8.25）是总生存率差的独立预测因素。
大肿瘤（直径≥7厘米）和低分化HCC更可能与肝静脉主干侵犯相关，肝内转移是与主要肝静脉主干接触的HCC患者的独立预后因素。
