Kojima Hidenobu, Hatano Etsuro, Taura Kojiro, Seo Satoru, Yasuchika Kentaro, Uemoto Shinji
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Dig Surg. 2015;32(6):413-20. doi: 10.1159/000437375. Epub 2015 Aug 29.
The prognosis of hepatocellular carcinoma (HCC) with tumor thrombus in the major portal vein has been extremely poor. We investigated the outcome of hepatic resection in HCC with major portal vein tumor thrombus (PVTT).
We retrospectively evaluated 52 consecutive patients who underwent hepatic resection for HCC with tumor thrombi in the first branch or trunk of the portal vein. Factors related to disease-free survival (DFS) and overall survival (OS) were analyzed.
The median DFS and OS times were 8.9 and 27.6 months for the whole cohort, respectively. Multiple tumors (hazard ratio 2.12; 95% CI 1.11-4.33; p = 0.023), positive surgical margins (hazard ratio 2.45; 95% CI 1.19-4.81; p = 0.016), and non-adjuvant hepatic arterial infusion chemotherapy (HAIC; hazard ratio 2.07; 95% CI 1.11-3.90; p = 0.023) were independent risk factors for DFS. Non-adjuvant HAIC (hazard ratio 1.84; 95% CI 1.01-3.37; p = 0.047) was an independent risk factor for OS.
Macroscopically curative resection seems to be of benefit to HCC patients with PVTT, even with tumor thrombi in the first branch or trunk of the portal vein. Adjuvant postoperative HAIC might improve DFS and OS in such patients.
伴有主要门静脉肿瘤血栓的肝细胞癌（HCC）预后极差。我们研究了伴有主要门静脉肿瘤血栓（PVTT）的HCC肝切除的结果。
我们回顾性评估了52例连续接受肝切除治疗的HCC患者，这些患者的门静脉第一分支或主干存在肿瘤血栓。分析了与无病生存期（DFS）和总生存期（OS）相关的因素。
整个队列的中位DFS和OS时间分别为8.9个月和27.6个月。多肿瘤（风险比2.12；95%置信区间1.11 - 4.33；p = 0.023）、手术切缘阳性（风险比2.45；95%置信区间1.19 - 4.81；p = 0.016）以及非辅助性肝动脉灌注化疗（HAIC；风险比2.07；95%置信区间1.11 - 3.90；p = 0.023）是DFS的独立危险因素。非辅助性HAIC（风险比1.84；95%置信区间1.01 - 3.37；p = 0.047）是OS的独立危险因素。
宏观上根治性切除似乎对伴有PVTT的HCC患者有益，即使门静脉第一分支或主干存在肿瘤血栓。术后辅助性HAIC可能改善此类患者的DFS和OS。
