Carr Brian I, Irish William, Federle Michael P
University of Pittsburgh Medical Center, Dept of Medical Oncology, Thomas Jefferson University, Philadelphia, USA.
Hepatogastroenterology. 2010 Nov-Dec;57(104):1375-81.
BACKGROUND/AIMS: Chemoembolization in the presence of portal vein thrombosis (PVT) is thought to be hazardous and such patients are regarded as prognostically poor.
One hundred sixty two patients with biopsy-proven and unresectable HCC were treated with chemoembolization (TACE). We retrospectively analyzed these patients according to presence or absence of PVT.
We found the 2 groups were similar with respect to tumor and liver parameters. Survival was 22.3 months in responders and 6.6 months in non-responders, p < or = 0.0001. Patients with PVT who responded had a 24 mo median survival and without PVT who responded had a 30 month median survival. These 2 groups were thus similar, p = 0.817. Patients who did not respond had a survival of only 5 and 7 months, for presence or absence of PVT, respectively. Responders had significantly lower blood AFP and GGTP levels, lower DCP levels and better liver function.
In this series, response was a major determinant of survival, regardless of the presence or absence of PVT. Thus, branch PVT was not a contraindication to chemoembolization.
背景/目的：门静脉血栓形成（PVT）患者行化疗栓塞被认为具有危险性，这类患者的预后被视为较差。
162例经活检证实且无法切除的肝细胞癌（HCC）患者接受了化疗栓塞（TACE）治疗。我们根据是否存在PVT对这些患者进行了回顾性分析。
我们发现两组在肿瘤和肝脏参数方面相似。有反应者的生存期为22.3个月，无反应者为6.6个月，p≤0.0001。有PVT且有反应的患者中位生存期为24个月，无PVT且有反应的患者中位生存期为30个月。这两组相似，p = 0.817。无论有无PVT，无反应者的生存期分别仅为5个月和7个月。有反应者的血液甲胎蛋白（AFP）和γ-谷氨酰转肽酶（GGTP）水平显著较低，脱-γ-羧基凝血酶原（DCP）水平较低且肝功能较好。
在本系列研究中，无论有无PVT，反应都是生存的主要决定因素。因此，分支型PVT并非化疗栓塞的禁忌证。
