Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Division of Hepato-Biliary-Pancreatic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
J Hepatol. 2014 Sep;61(3):583-8. doi: 10.1016/j.jhep.2014.04.032. Epub 2014 May 4.
BACKGROUND & AIMS: Presence of hepatic vein tumor thrombosis (HVTT) in patients with hepatocellular carcinoma (HCC) is regarded as signaling an extremely poor prognosis. However, little is known about the prognostic impact of surgical treatment for HVTT.
Our database of surgical resection for HCC between October 1994 and December 2011 in a tertiary care Japanese hospital was retrospectively analysed. We statistically compared the patient characteristics and surgical outcomes in HCC patients with tumor thrombosis in a peripheral hepatic vein, including microscopic invasion (pHVTT), tumor thrombosis in a major hepatic vein (mHVTT), and tumor thrombosis of the inferior vena cava (IVCTT). Among 1525 hepatic resections, 153 cases of pHVTT, 21 cases of mHVTT, and 13 cases of IVCTT were identified.
The median survival time (MST) in the pHVTT and mHVTT groups was 5.27 and 3.95 years, respectively (p=0.77), and the median time to recurrence (TTR) was 1.06 and 0.41 years, respectively (p=0.74). On the other hand, the MST and TTR in the patient group with IVCTT were 1.39 years and 0.25 year respectively; furthermore, the MST of Child-Pugh class B patients was significantly worse (2.39 vs. 0.44 years, p=0.0001). Multivariate analyses revealed IVCTT (risk ratio [RR] 2.54, p=0.024) and R 1/2 resection (RR 2.08, p=0.017) as risk factors for the overall survival.
Hepatic resection provided acceptable outcomes in HCC patients with mHVTT or pHVTT when R0 resection was feasible. Resection of HCC may be attempted even in patients with IVCTT, in the presence of good liver function.
肝细胞癌（HCC）患者存在肝静脉肿瘤血栓（HVTT）被认为预后极差。然而，对于 HVTT 的手术治疗的预后影响知之甚少。
我们回顾性分析了 1994 年 10 月至 2011 年 12 月期间在一家日本三级医疗机构接受肝切除术治疗 HCC 的患者数据库。我们对存在外周性肝静脉肿瘤血栓（包括显微镜下侵犯性肿瘤血栓（pHVTT）、大肝静脉肿瘤血栓（mHVTT）和下腔静脉肿瘤血栓（IVCTT）的 HCC 患者的临床特征和手术结果进行了统计学比较。在 1525 例肝切除术中，发现 153 例 pHVTT、21 例 mHVTT 和 13 例 IVCTT。
pHVTT 和 mHVTT 组的中位生存时间（MST）分别为 5.27 年和 3.95 年（p=0.77），中位复发时间（TTR）分别为 1.06 年和 0.41 年（p=0.74）。另一方面，IVCTT 组的 MST 和 TTR 分别为 1.39 年和 0.25 年；此外，Child-Pugh 分级 B 患者的 MST 明显更差（2.39 年与 0.44 年，p=0.0001）。多因素分析显示 IVCTT（风险比 [RR] 2.54，p=0.024）和 R1/2 切除（RR 2.08，p=0.017）是总生存的危险因素。
当可行 R0 切除时，肝切除术可为 mHVTT 或 pHVTT 的 HCC 患者提供可接受的结果。即使肝功能良好，也可以尝试对 IVCTT 患者进行 HCC 切除术。
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