Faber Wladimir, Stockmann Martin, Kruschke Johannes Eberhard, Denecke Timm, Bahra Marcus, Seehofer Daniel
Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Dig Surg. 2014;31(3):204-9. doi: 10.1159/000365257. Epub 2014 Sep 2.
Long-term data after liver resection for hepatocellular carcinoma (HCC) with vascular invasion are rare for non-Asian patients. The aim of the present study was to analyze the long-term outcome of liver resection for HCC with vascular invasion and to compare the results of subgroups with micro- and macrovascular invasion.
From January 2000 to September 2010, 288 patients without extrahepatic metastases underwent liver resection for HCC. In 107 out of 288 patients (37%), vascular invasion was found in the final pathological analysis. The long-term outcome as well as the perioperative course of these patients was analyzed using a prospective database.
The 1-, 3- and 5-year cumulative survival rate of HCC patients with vascular invasion was 64.3, 41.4 and 23.9%, respectively. The median survival was 19 months. In the multivariate analysis, the overall survival was not influenced by the type of vascular invasion (micro- vs. macrovascular invasion), however overall survival was significantly impaired in case of lymphatic vessel invasion, intraoperative blood transfusions, need of fresh frozen plasma application, prolonged ICU stay and elevated preoperative bilirubin levels.
Acceptable survival rates can be achieved in selected patients with macrovascular invasion after surgical resection, which is not markedly different from those with microvascular invasion. In view of an otherwise poor prognosis, liver resection seems to be justified for selected HCC patients with macrovascular invasion, although this stands in contrast with the BCLC recommendations. However, it is in accordance for example with the guidelines of the Asia-Pacific Association for the Study of the Liver.
非亚洲患者肝细胞癌（HCC）伴血管侵犯行肝切除术后的长期数据较为少见。本研究旨在分析HCC伴血管侵犯行肝切除术后的长期预后，并比较微血管侵犯和大血管侵犯亚组的结果。
2000年1月至2010年9月，288例无肝外转移的患者接受了HCC肝切除术。288例患者中有107例（37%）在最终病理分析中发现血管侵犯。使用前瞻性数据库分析这些患者的长期预后以及围手术期过程。
HCC伴血管侵犯患者的1年、3年和5年累积生存率分别为64.3%、41.4%和23.9%。中位生存期为19个月。多因素分析中，总体生存不受血管侵犯类型（微血管侵犯与大血管侵犯）的影响，然而，发生淋巴管侵犯、术中输血、需要应用新鲜冰冻血浆、ICU住院时间延长和术前胆红素水平升高时，总体生存会显著受损。
部分大血管侵犯患者手术切除后可获得可接受的生存率，与微血管侵犯患者的生存率无明显差异。鉴于其他方面预后较差，对于部分大血管侵犯的HCC患者，肝切除似乎是合理的，尽管这与巴塞罗那临床肝癌（BCLC）分期系统的建议相悖。然而，这与例如亚太肝病研究学会的指南是一致的。
