Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China.
World J Gastroenterol. 2021 Apr 7;27(13):1330-1340. doi: 10.3748/wjg.v27.i13.1330.
The factors affecting the short-term and long-term prognosis of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) receiving transarterial chemoembolization (TACE) are still unclear.
To clarify the predictors correlated with the short-term and long-term survival of HCC patients with PVTT who underwent TACE.
The medical records of 181 HCC patients with PVTT who underwent TACE at the Second Affiliated Hospital of Chongqing Medical University from January 2015 to July 2019 were retrospectively analyzed. We explored the short-term and long-term prognostic factors by comparing the preoperative indicators of patients who died and survived within 3 mo and 12 mo after TACE. Multivariate analyses were conducted using logistic regression. The area under the receiver operating characteristic curve (area under curve) was used to evaluate the predictive ability of the factors related to the short-term and long-term prognosis.
The median survival time was 4.8 mo (range: 2.5-8.85 mo). The 3 mo, 6 mo, and 12 mo survival rates were 68.5%, 38.7%, and 15.5%, respectively. In multivariable analysis, total bilirubin, sex, and aspartate aminotransferase (AST) were closely linked to short-term survival. When AST ≥ 87 U/L and total bilirubin ≥ 16.15 µmol/L, the 3-mo survival rate after TACE was reduced significantly ( < 0.05). AST had the best predictive ability, followed by total bilirubin, while sex had the worst predictive ability for short-term survival area under curve: 0.763 (AST) 0.707 (total bilirubin) 0.554 (sex)]. The long-term survival outcome was significantly better in patients with a single lesion than in those with ≥ three lesions ( = 0.009). Patients with massive block HCC had a worse long-term survival than patients with nodular and diffuse HCC ( = 0.001).
AST, total bilirubin, and sex are independent factors associated with short-term survival. The number of tumors and the gross pathological type of tumor are related to the long-term outcome.
经动脉化疗栓塞术（TACE）治疗肝细胞癌（HCC）合并门静脉癌栓（PVTT）患者的短期和长期预后的影响因素仍不清楚。
明确与接受 TACE 治疗的 HCC 合并 PVTT 患者短期和长期生存相关的预测因素。
回顾性分析 2015 年 1 月至 2019 年 7 月在重庆医科大学第二附属医院接受 TACE 治疗的 181 例 HCC 合并 PVTT 患者的病历资料。比较 TACE 治疗后 3 个月和 12 个月内死亡和存活患者的术前指标，探讨短期和长期预后的预测因素。采用 logistic 回归进行多变量分析。采用受试者工作特征曲线（ROC 曲线）下面积（AUC）评估与短期和长期预后相关因素的预测能力。
中位生存时间为 4.8 个月（范围：2.5-8.85 个月）。3 个月、6 个月和 12 个月的生存率分别为 68.5%、38.7%和 15.5%。多变量分析显示，总胆红素、性别和天冬氨酸转氨酶（AST）与短期生存密切相关。当 AST≥87 U/L 和总胆红素≥16.15 μmol/L 时，TACE 治疗后 3 个月的生存率显著降低（<0.05）。AST 对短期生存的预测能力最好，其次是总胆红素，而性别对短期生存的预测能力最差。ROC 曲线下面积：AST（0.763）>总胆红素（0.707）>性别（0.554）。单发肿瘤患者的长期生存结果明显优于多发肿瘤患者（=0.009）。巨块型 HCC 患者的长期生存结果明显差于结节型和弥漫型 HCC 患者（=0.001）。
AST、总胆红素和性别是与短期生存相关的独立因素。肿瘤数量和肿瘤大体病理类型与长期预后有关。
