Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, People's Republic of China.
Chinese Liver Cancer with Portal Vein Thrombus Consortium, Shanghai, People's Republic of China.
Hepatol Int. 2020 Sep;14(5):754-764. doi: 10.1007/s12072-020-10032-2. Epub 2020 Apr 6.
Liver resection for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) offers a chance of cure, although survival is often limited. The actual 3-year survival and its associated prognostic factors have not been reported.
A nationwide database of HCC patients with PVTT who underwent liver resection with 'curative' intent was analyzed. The clinicopathologic characteristics, the perioperative, and survival outcomes for the actual long-term survivors were compared with the non-long-term survivors (patients who died within 3 years of surgery). Univariable and multivariable regression analyses were performed to identify predictive factors associated with long-term survival outcomes.
The study included 1590 patients with an actuarial 3-year survival of 16.6%, while the actual 3-year survival rate was 11.7%. There were 171 patients who survived for at least 3 years after surgery and 1290 who died within 3 years of surgery. Multivariable regression analysis revealed that total bilirubin > 17.1 μmol/l, AFP > 400 ng/ml, types of hepatectomy, extent of PVTT, intraoperative blood loss > 400 ml, tumor diameter > 5 cm, tumor encapsulation, R0 resection, liver cirrhosis, adjuvant TACE, postoperative early recurrence (< 1 year), and recurrence treatments were independent prognostic factors associated with actual long-term survival.
One in nine HCC patients with PVTT reached the long-term survival milestone of 3 years after resection. Major hepatectomy, controlling intraoperative blood loss, R0 resection, adjuvant TACE, and 'curative' treatment for initial recurrence should be considered for patients to achieve better long-term survival outcomes.
对于伴有门静脉癌栓（PVTT）的肝细胞癌（HCC）患者，进行肝切除术有治愈的机会，尽管生存时间往往有限。尚未报道实际的 3 年生存率及其相关的预后因素。
对行“治愈性”肝切除术治疗伴有 PVTT 的 HCC 患者的全国性数据库进行了分析。比较了实际长期生存者与非长期生存者（术后 3 年内死亡的患者）的临床病理特征、围手术期和生存结局。进行单变量和多变量回归分析，以确定与长期生存结局相关的预测因素。
本研究纳入了 1590 例患者，其术后 3 年的实际生存率为 16.6%，而术后 3 年的实际生存率为 11.7%。术后至少生存 3 年的患者有 171 例，术后 3 年内死亡的患者有 1290 例。多变量回归分析显示，总胆红素>17.1μmol/l、AFP>400ng/ml、肝切除术类型、PVTT 程度、术中出血量>400ml、肿瘤直径>5cm、肿瘤包膜、R0 切除、肝硬化、辅助 TACE、术后早期复发（<1 年）和复发治疗是与实际长期生存相关的独立预后因素。
在伴有 PVTT 的 HCC 患者中，每 9 例患者中就有 1 例达到了 3 年的长期生存里程碑。对于患者来说，应考虑进行大的肝切除术、控制术中出血量、R0 切除、辅助 TACE 以及对初始复发进行“治愈性”治疗，以获得更好的长期生存结局。
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