Komatsu Shohei, Kido Masahiro, Kuramitsu Kaori, Tsugawa Daisuke, Gon Hidetoshi, Fukushima Kenji, Urade Takeshi, Yanagimoto Hiroaki, Toyama Hirochika, Fukumoto Takumi
Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
J Gastrointest Surg. 2022 Apr;26(4):822-830. doi: 10.1007/s11605-021-05181-0. Epub 2021 Oct 29.
Optimal treatment strategies for advanced hepatocellular carcinoma (HCC) with macroscopic portal vein tumor thrombus (PVTT) remain controversial. Therefore, this study aimed to assess the impact and predictive factors of hepatectomy for HCC with macroscopic PVTT.
This study included 100 patients who presented with intraoperatively confirmed PVTT extending to the first portal branch (Vp3), main portal trunk, or opposite-side portal branch (Vp4) between June 2000 and December 2019. Their postoperative outcomes and predictive factors for survival were evaluated.
Of the 100 patients, 37 (37%) and 63 (63%) had Vp3 and Vp4 PVTTs, respectively. Moreover, 42 (42%) and 58 (58%) patients underwent R0/1 and R2 hepatectomies, respectively. The median survival time (MST) of all patients with Vp3/4 PVTT was 14.5 months; the 1- and 3-year overall survival rates were 59.6 and 16.8%, respectively. The MSTs of patients with Vp3 and Vp4 PVTTs were 16.1 and 14.3 months, respectively (P = 0.7098). The MSTs of patients who underwent R0/1 and R2 hepatectomies were 14.3 and 14.9 months, respectively (P = 0.3831). All assessed tumor factors (including the Vp status [Vp3 or Vp4], type of resection [R0/1 or R2], intrahepatic maximal tumor size, intrahepatic tumor number, and the existence of extrahepatic metastasis) did not influence the overall survival significantly.
Tumor factors, such as the presence of a Vp3/4 PVTT, have a strong impact on survival; however, other multiple tumor factors have a limited impact. Hepatectomy can be an effective treatment option for HCC with Vp3/4 PVTT, and its indications should be considered.
对于伴有肉眼可见门静脉癌栓（PVTT）的晚期肝细胞癌（HCC），最佳治疗策略仍存在争议。因此，本研究旨在评估肝切除术对伴有肉眼可见PVTT的HCC的影响及预测因素。
本研究纳入了2000年6月至2019年12月期间术中证实PVTT延伸至第一门静脉分支（Vp3）、门静脉主干或对侧门静脉分支（Vp4）的100例患者。评估了他们的术后结局及生存预测因素。
100例患者中，分别有37例（37%）和63例（63%）存在Vp3和Vp4 PVTT。此外，分别有42例（42%）和58例（58%）患者接受了R0/1和R2肝切除术。所有Vp3/4 PVTT患者的中位生存时间（MST）为14.5个月；1年和3年总生存率分别为59.6%和16.8%。Vp3和Vp4 PVTT患者的MST分别为16.1个月和14.3个月（P = 0.7098）。接受R0/1和R2肝切除术患者的MST分别为14.3个月和14.9个月（P = 0.3831）。所有评估的肿瘤因素（包括Vp状态[Vp3或Vp4]、切除类型[R0/1或R2]、肝内最大肿瘤大小、肝内肿瘤数量以及肝外转移的存在）对总生存均无显著影响。
诸如Vp3/4 PVTT的存在等肿瘤因素对生存有强烈影响；然而，其他多种肿瘤因素的影响有限。肝切除术对于伴有Vp3/4 PVTT的HCC可能是一种有效的治疗选择，应考虑其适应证。
