Silva Jack P, Berger Nicholas G, Tsai Susan, Christians Kathleen K, Clarke Callisia N, Mogal Harveshp, White Sarah, Rilling William, Gamblin T Clark
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA.
HPB (Oxford). 2017 Aug;19(8):659-666. doi: 10.1016/j.hpb.2017.04.016. Epub 2017 May 25.
Transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) remains controversial. This systematic review sought to examine the role of TACE in the treatment of HCC with PVT in either the main portal vein (MPV) or portal vein branches (PVB).
PubMed was searched for "hepatocellular carcinoma" and "transarterial chemoembolization" from January 1, 2006 to August 31, 2016. Cohorts treated with TACE for HCC with PVT were included. Meta-analysis of overall survival (OS), mRECIST response, and complication incidence was performed. MPV and PVB subgroups were compared.
Of 136 search results, 13 studies with 1933 TACE patients were included. Median OS (95% CI) was eight (5-15) months. Survival rates after one, three, and five years were 29% (20%-40%), 4% (1%-11%), and 1% (0%-5%), respectively. Only 1% experienced liver failure and 18% had post-treatment complications. Patients with MPV thrombosis had worse survival than PVB patients (p < 0.001), but similar mRECIST response rates (14% vs. 16%, p = 0.238).
TACE is a safe treatment for a highly selected population of HCC patients with PVT. Despite worse survival rates compared to PVB thrombosis, PVT in the MPV should not be considered an absolute contraindication to TACE.
经动脉化疗栓塞术（TACE）用于治疗伴有门静脉血栓形成（PVT）的肝细胞癌（HCC）仍存在争议。本系统评价旨在探讨TACE在治疗主门静脉（MPV）或门静脉分支（PVB）存在PVT的HCC中的作用。
检索PubMed中2006年1月1日至2016年8月31日期间关于“肝细胞癌”和“经动脉化疗栓塞术”的文献。纳入接受TACE治疗伴有PVT的HCC患者队列。对总生存期（OS）、改良RECIST反应及并发症发生率进行荟萃分析。比较MPV和PVB亚组。
136条检索结果中，纳入13项研究共1933例接受TACE治疗的患者。中位OS（95%CI）为8（5 - 15）个月。1年、3年和5年生存率分别为29%（20% - 40%）、4%（1% - 11%）和1%（0% - 5%）。仅1%发生肝衰竭，18%出现治疗后并发症。MPV血栓形成患者的生存期较PVB患者差（p < 0.001），但改良RECIST反应率相似（14%对16%，p = 0.238）。
TACE对于高度选择的伴有PVT的HCC患者群体是一种安全的治疗方法。尽管与PVB血栓形成相比生存率较差，但MPV中的PVT不应被视为TACE的绝对禁忌证。
