Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
J Am Coll Surg. 2016 Jun;222(6):1138-1148.e2. doi: 10.1016/j.jamcollsurg.2016.03.023. Epub 2016 Mar 26.
Portal vein embolization (PVE) is useful to expand the indications of major hepatectomy; however, its oncologic effects are not fully understood. This study aimed to confirm the efficacy of preoperative PVE for hepatocellular carcinoma patients.
Between 2000 and 2012, five hundred and ten patients with hepatocellular carcinoma undergoing right-side hemihepatectomy were enrolled (PVE group, n = 162 and non-PVE group, n = 348). To equalize background factors, one-to-one propensity case-matched analysis and multivariate analysis were performed. Short- and long-term outcomes were evaluated.
Propensity score-matched patients, 148 in each group, were selected. The percentage of resected liver volume on admission was significantly greater in the PVE group (60.5% vs 48.3%; p < 0.001), but decreased considerably after PVE, from 60.5% to 50.3% (p < 0.001). The 5-year cumulative recurrence-free survival (36.4% vs 35.3%) and overall survival (58.6% vs 52.8%) rates were comparable. Extrahepatic recurrences were less common in the PVE group (18.1% vs 38.8%; p = 0.004). Independent prognostic factors for recurrence-free survival were morbidity (hazard ratio [HR] = 1.56), multiple tumors (HR = 1.97), red cell concentrate administration (HR = 1.57), older age (HR = 2.09), and massive portal invasion (HR = 2.33); and those for overall survival were morbidity (HR = 2.37), multiple tumors (HR = 1.71), and massive hepatic venous invasion (HR = 3.49).
Even though hepatocellular carcinoma patients who underwent preoperative PVE and right-side hemihepatectomy had a significantly larger resected liver volume on admission, they have a comparable long-term prognosis as patients with up front hepatectomy. In addition, PVE might decrease extrahepatic recurrences.
门静脉栓塞术（PVE）可用于扩大肝切除术的适应证；然而，其对肿瘤的影响尚不完全清楚。本研究旨在确认术前 PVE 对肝细胞癌患者的疗效。
2000 年至 2012 年间，510 例接受右半肝切除术的肝细胞癌患者被纳入研究（PVE 组，n=162 例；非 PVE 组，n=348 例）。为了均衡背景因素，进行了 1:1 倾向评分匹配分析和多变量分析。评估了短期和长期结果。
选择了每组 148 例倾向评分匹配的患者。PVE 组入院时切除的肝体积百分比显著较大（60.5%比 48.3%；p<0.001），但 PVE 后明显下降，从 60.5%降至 50.3%（p<0.001）。5 年累积无复发生存率（36.4%比 35.3%）和总生存率（58.6%比 52.8%）相似。PVE 组肝外复发较少（18.1%比 38.8%；p=0.004）。无复发生存的独立预后因素为并发症（风险比[HR]1.56）、多发肿瘤（HR 1.97）、红细胞浓缩液输注（HR 1.57）、年龄较大（HR 2.09）和广泛门静脉侵犯（HR 2.33）；总生存的独立预后因素为并发症（HR 2.37）、多发肿瘤（HR 1.71）和广泛肝静脉侵犯（HR 3.49）。
尽管接受术前 PVE 和右半肝切除术的肝细胞癌患者入院时切除的肝体积明显较大，但他们的长期预后与直接肝切除术患者相当。此外，PVE 可能减少肝外复发。
