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.
Surgery. 2019 Apr;165(4):696-702. doi: 10.1016/j.surg.2018.10.023. Epub 2018 Nov 19.
Portal vein embolization has been used worldwide to induce hypertrophy of the future liver remnant and to reduce the risk of hepatic insufficiency and death after major hepatectomy. However, whether disease progression after portal vein embolization can affect long-term oncologic outcomes in patients with hepatocellular carcinoma is uncertain.
From a total of 107 patients who underwent portal vein embolization and subsequent hepatectomy between 2000 and 2016, 57 patients with hepatocellular carcinoma were enrolled. We evaluated their long-term oncologic outcomes and investigated whether the disease progression between portal vein embolization and subsequent hepatectomy affected survival.
The 5-year overall survival and disease-free survival after hepatectomy were 74.5% and 31.7%, respectively. Multivariate analyses revealed that tumor number before hepatectomy ≥3 (hazard ratio 3.59, P = .019), des-γ-carboxy prothrombin >200 mAU/mL (hazard ratio 3.36, P = .045), and red blood cell transfusion (hazard ratio 11.03, P = .0008) were independent prognostic factors for overall survival. Male sex (hazard ratio 3.74, P = .029), bilobar tumor distribution (hazard ratio 3.65, P = .004), and red blood cell transfusion (hazard ratio 6.22, P = .0026) were independent prognostic factors for disease-free survival. Disease progressions after portal vein embolization, including increases in tumor size, tumor number, α-fetoprotein, lens culinaris agglutinin-reactive fraction of α-fetoprotein, and des-γ-carboxy prothrombin, were observed in 22.8%, 14.0%, 29.8%, 19.3%, and 47.4% of patients, respectively. Only an increase of tumor number significantly decreased the disease-free survival rate after hepatectomy in a univariate analysis, and none of the variables affected overall survival.
Disease progression after portal vein embolization did not affect long-term survival in patients with hepatocellular carcinoma if the planned subsequent hepatectomy could be completed.
门静脉栓塞术已在全球范围内用于诱导未来肝残的肥大，并降低大肝切除术后肝衰竭和死亡的风险。然而，门静脉栓塞术后疾病进展是否会影响肝细胞癌患者的长期肿瘤学结局尚不确定。
从 2000 年至 2016 年间接受门静脉栓塞术和随后肝切除术的 107 例患者中，纳入了 57 例肝细胞癌患者。我们评估了他们的长期肿瘤学结局，并研究了门静脉栓塞术和随后的肝切除术后疾病进展是否影响生存。
肝切除术后 5 年总生存率和无病生存率分别为 74.5%和 31.7%。多变量分析显示，肝切除术前肿瘤数量≥3（风险比 3.59，P=0.019）、去γ-羧基凝血酶原>200 mAU/mL（风险比 3.36，P=0.045）和红细胞输注（风险比 11.03，P=0.0008）是总生存率的独立预后因素。男性（风险比 3.74，P=0.029）、双叶肿瘤分布（风险比 3.65，P=0.004）和红细胞输注（风险比 6.22，P=0.0026）是无病生存率的独立预后因素。门静脉栓塞术后观察到疾病进展，包括肿瘤大小、肿瘤数量、甲胎蛋白、扁豆凝集素反应性甲胎蛋白、去γ-羧基凝血酶原的增加，分别在 22.8%、14.0%、29.8%、19.3%和 47.4%的患者中出现。仅肿瘤数量的增加在单因素分析中显著降低了肝切除术后的无病生存率，而没有一个变量影响总生存率。
如果计划的后续肝切除术能够完成，肝细胞癌患者门静脉栓塞术后疾病进展不会影响长期生存。
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