埃及肝细胞癌合并门静脉分支血栓形成患者经动脉化疗栓塞的疗效
Outcome of transarterial chemoembolization in Egyptian patients with hepatocellular carcinoma and branch portal vein thrombosis.
作者信息
Abdella H, Shaker M K, Montasser Iman Fawzy, Sobhi M, Aly H, Sayed A, Saleh S, El Dorry A
机构信息
Departments of Tropical Medicine, Faculty of Medicine, Ain Shams University, Abbassia Square, Cairo, 11341, Egypt.
Radiodiagnosis and Intervention Radiology, Ain Shams University, Cairo, Egypt.
出版信息
Indian J Gastroenterol. 2018 Mar;37(2):127-132. doi: 10.1007/s12664-018-0830-4. Epub 2018 Mar 13.
BACKGROUND/AIM: Portal vein tumor thrombosis (PVTT) is a common complication in hepatocellular carcinoma (HCC) and it was considered a relative contraindication for transarterial chemoembolization (TACE) by many centers. This study aimed to assess the outcomes after TACE in patients with branch PVT regarding Child classification, radiological response, and 1-year survival.
METHODS
Thirty HCC patients (24 male, 6 females) Child A cirrhotics with branch PVT underwent TACE. Follow up was done at 1, 3, 6, and 12 months after first TACE. All patients underwent laboratory investigations including liver function tests to assess deterioration in liver functions and triphasic spiral computed tomography to assess radiological response according to modified response evaluation criteria in solid tumors (mRECIST) criteria, and survival analysis was recorded.
RESULTS
TACE succeeded to achieve disease control in 93.3%, 86.3%, 57.7%, and 44.4% of patients after 1, 3, 6, and 12 months, respectively. Post-TACE liver decompensation occurred in the form of ascites in 30%, jaundice in 10%, and hepatic encephalopathy in 3.3% within 1 month of TACE. One month survival after TACE was 100%, 3 months was 96.6%, 6 months was 86.6%, and 1-year survival was 60%. Mean overall survival of the included patients was 17 months (SE = 1.59).
CONCLUSION
TACE seems an alternative option for patients with unrespectable HCC with portal vein thrombosis in patients with good liver function tests.
背景/目的：门静脉肿瘤血栓形成（PVTT）是肝细胞癌（HCC）的常见并发症，许多中心将其视为经动脉化疗栓塞术（TACE）的相对禁忌证。本研究旨在评估分支门静脉肿瘤血栓形成（PVT）患者接受TACE后的疗效，包括Child分级、影像学反应和1年生存率。
方法
30例Child A级肝硬化合并分支PVT的HCC患者接受了TACE。在首次TACE后的1、3、6和12个月进行随访。所有患者均接受实验室检查，包括肝功能测试以评估肝功能恶化情况，以及三相螺旋计算机断层扫描以根据实体瘤改良反应评估标准（mRECIST）评估影像学反应，并记录生存分析情况。
结果
TACE分别在1、3、6和12个月后使93.3%、86.3%、57.7%和44.4%的患者实现了疾病控制。TACE后1个月内，以腹水形式出现的TACE后肝失代偿发生率为30%，黄疸为10%，肝性脑病为3.3%。TACE后1个月生存率为100%，3个月为96.6%，6个月为86.6%，1年生存率为60%。纳入患者的平均总生存期为17个月（标准误=1.59）。
结论
对于肝功能检查良好的不可切除HCC合并门静脉血栓形成的患者，TACE似乎是一种替代选择。
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