Imai Katsunori, Yamashita Yo-Ichi, Nakao Yosuke, Matsumoto Takashi, Kinoshita Shotaro, Yusa Toshihiko, Kitano Yuki, Kaida Takayoshi, Hayashi Hiromitsu, Baba Hideo
Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
Ann Surg Oncol. 2021 Feb;28(2):854-862. doi: 10.1245/s10434-020-08960-2. Epub 2020 Aug 1.
Portal vein embolization (PVE) was developed for patients with insufficient future liver remnant volume and function and has gained relevant support worldwide before major hepatectomy. However, the efficacy of preoperative PVE for hepatocellular carcinoma (HCC) patients with impaired liver function remains uncertain.
Ninety-seven HCC patients who were scheduled for PVE followed by hepatectomy were enrolled in this study. Their short- and long-term outcomes were investigated, according to the liver damage classification defined by the Liver Cancer Study Group of Japan.
Of 97 patients who underwent preoperative PVE, 30 (32.4%) could not undergo subsequent hepatectomy. Dropout rate from treatment strategy was significantly higher in patients with liver damage B (n = 13, 61.5%) than in those with liver damage A (n = 84, 26.2%) (P = 0.014). Among the 67 patients who underwent planned hepatectomy after PVE, 53 were categorized to liver damage A, and 14 were categorized to liver damage B at the point of hepatectomy. Although major complication and mortality rates were comparable between the two groups, the cumulative overall survival (OS) and disease-free survival (DFS) after hepatectomy were markedly worse in patients with liver damage B than in those with liver damage A (5-year OS rate: 23.1% vs 74.6%, P = 0.014, 5-year DFS rate: 7.8% vs 33.5%, P = 0.054, respectively).
The treatment strategy of PVE followed by hepatectomy might be a contraindication for HCC patients with impaired liver function categorized as liver damage B because of the higher dropout rate and poorer long-term outcomes after hepatectomy.
门静脉栓塞术（PVE）是为未来肝剩余体积和功能不足的患者开发的，在全球范围内，该技术在大型肝切除术前已获得相关支持。然而，术前PVE对肝功能受损的肝细胞癌（HCC）患者的疗效仍不确定。
本研究纳入了97例计划接受PVE然后肝切除术的HCC患者。根据日本肝癌研究组定义的肝损伤分类，对他们的短期和长期结局进行了调查。
在97例行术前PVE的患者中，30例（32.4%）无法进行后续肝切除术。B级肝损伤患者（n = 13，61.5%）的治疗策略退出率显著高于A级肝损伤患者（n = 84，26.2%）（P = 0.014）。在PVE后接受计划肝切除术的67例患者中，53例在肝切除时被归类为A级肝损伤，14例被归类为B级肝损伤。虽然两组的主要并发症和死亡率相当，但B级肝损伤患者肝切除术后的累积总生存期（OS）和无病生存期（DFS）明显差于A级肝损伤患者（5年OS率：23.1%对74.6%，P = 0.014；5年DFS率：7.8%对33.5%，P = 0.054）。
对于肝功能受损且被归类为B级肝损伤的HCC患者，PVE后肝切除术的治疗策略可能是禁忌，因为其退出率较高且肝切除术后长期结局较差。
