Ronot Maxime, Cauchy François, Gregoli Bettina, Breguet Romain, Allaham Wassim, Paradis Valérie, Soubrane Olivier, Vilgrain Valérie
Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
Department of HBP Surgery and Liver Transplantation, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.
HPB (Oxford). 2016 Aug;18(8):684-90. doi: 10.1016/j.hpb.2016.05.012. Epub 2016 Jun 18.
To investigate the long-term oncological outcome of patients with resectable hepatocellular carcinoma (HCC) undergoing sequential transarterial chemoembolization (TACE) and portal vein embolization (PVE).
Analysis of all Child A HCC patients who underwent TACE-PVE before major liver resection from 2006 to 2012 was performed according to whether or not they underwent surgical resection as planned.
54 patients (50 men, 93% median 69-years (range 44-87)) were included. Thirty-nine (72%) patients underwent resection, including 19/25, 16/23, and 4/6 of patients with BCLC A, B, and C (p = 0.839). Twenty-two (56%) had tumor recurrence (median delay 10 months) including 9/19, 11/16, and 2/4 of the patients with BCLC A, B, and C (p = 0.430). Survival was significantly better in resected patients as compared to those who were not resected (median overall survival (OS): 44 vs. 18 months; p < 0.001). Recurrence was associated with a poorer prognosis as compared to patients without recurrence (median OS 43 months vs. not reached; p < 0.001). BCLC stage did not influence survival (p = 0.13).
In patients with large unilobar HCC, TACE-PVE leads to resection in most patients, with a good oncological outcome regardless of the tumor burden. When this strategy fails, patients can be managed with TACE despite prior PVE.
探讨可切除肝细胞癌（HCC）患者序贯经动脉化疗栓塞术（TACE）和门静脉栓塞术（PVE）后的长期肿瘤学结局。
对2006年至2012年在肝大部切除术前接受TACE-PVE的所有Child A级HCC患者，根据其是否按计划接受手术切除进行分析。
纳入54例患者（50例男性，93%，中位年龄69岁（范围44-87岁））。39例（72%）患者接受了切除，其中BCLC A、B和C期患者分别为19/25、16/23和4/6例（p = 0.839）。22例（56%）出现肿瘤复发（中位延迟时间10个月），其中BCLC A、B和C期患者分别为9/19、11/16和2/4例（p = 0.430）。与未切除的患者相比，切除患者的生存率显著更高（中位总生存期（OS）：44个月对18个月；p < 0.001）。与未复发的患者相比，复发患者的预后较差（中位OS 43个月对未达到；p < 0.001）。BCLC分期不影响生存率（p = 0.13）。
对于巨大单叶HCC患者，TACE-PVE可使大多数患者接受切除，无论肿瘤负荷如何，肿瘤学结局良好。当该策略失败时，尽管之前进行了PVE，患者仍可采用TACE治疗。
