肝切除术与索拉非尼治疗伴有宏观门静脉癌栓的晚期肝细胞癌：一项两机构倾向评分匹配队列研究。

Hepatectomy versus sorafenib for advanced hepatocellular carcinoma with macroscopic portal vein tumor thrombus: A bi-institutional propensity-matched cohort study.

机构信息

Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan.

出版信息

J Hepatobiliary Pancreat Sci. 2023 Mar;30(3):303-314. doi: 10.1002/jhbp.1236. Epub 2022 Sep 15.

DOI:10.1002/jhbp.1236

PMID:36047804

Abstract

AIM

Sorafenib was previously considered a first-line treatment for hepatocellular carcinoma (HCC) patients with macroscopic portal vein tumor thrombus (PVTT). This case-matched analysis was performed to evaluate the best first-line treatment for HCC in patients with macroscopic PVTT.

METHODS

The HCC patients with Vp2 (PVTT invaded into a second-order portal branch), Vp3 (first-order portal branch), and Vp4 (main trunk or contralateral portal vein) PVTT who underwent hepatectomy and those treated with sorafenib were included. Treatment results were compared between the two modalities for each PVTT category, and a propensity analysis was performed for patients with Vp3 and Vp4 (Vp3/4).

RESULTS

The median survival times (MSTs) of patients with Vp2, Vp3, and Vp4 PVTT who underwent hepatectomy were 21.4, 13.6, and 14.9 months, respectively; the MSTs for those with Vp2, Vp3, and Vp4 PVTT who received sorafenib treatment were 6.9, 5.5, and 3.6 months, respectively, with a significant difference. In a propensity-matched cohort of patients with Vp3/4 PVTT (36 patients in each), the MST of patients who underwent hepatectomy (15.1 months) was significantly better than the patients treated with sorafenib (4.5 months).

CONCLUSION

Hepatectomy can be associated with prolonged survival in HCC patients with macroscopic PVTT.

摘要

目的

索拉非尼此前被认为是伴有宏观门静脉癌栓（PVTT）的肝细胞癌（HCC）患者的一线治疗药物。本病例匹配分析旨在评估伴有宏观 PVTT 的 HCC 患者的最佳一线治疗方法。

方法

纳入接受肝切除术的 HCC 伴有 Vp2（PVTT 侵犯二级门静脉分支）、Vp3（一级门静脉分支）和 Vp4（主干或对侧门静脉）PVTT 以及接受索拉非尼治疗的患者。比较两种治疗方法在每个 PVTT 类别中的治疗结果，并对 Vp3 和 Vp4（Vp3/4）患者进行倾向评分分析。

结果

接受肝切除术的 Vp2、Vp3 和 Vp4 PVTT 患者的中位生存时间（MST）分别为 21.4、13.6 和 14.9 个月；接受索拉非尼治疗的 Vp2、Vp3 和 Vp4 PVTT 患者的 MST 分别为 6.9、5.5 和 3.6 个月，差异有统计学意义。在 Vp3/4 PVTT（每组 36 例）的倾向性匹配队列中，接受肝切除术的患者（15.1 个月）的 MST 明显优于接受索拉非尼治疗的患者（4.5 个月）。