Guo Wei-Xing, Yang Shi-Ye, Guo Lei, Feng Jin-Kai, Xue Jie, Shi Jie, Lau Wan Yee, Yu Dong, Cheng Shu-Qun
Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Pathol Res Pract. 2023 Jan;241:154260. doi: 10.1016/j.prp.2022.154260. Epub 2022 Dec 9.
Portal vein tumour thrombus (PVTT) in patients with hepatocellular carcinoma (HCC) is known as a major complication associated with poor survival. We clinically defined a new and rare type of HCC, PVTT-type HCC (PVTT-HCC), in a small group of HCC patients with HCC presenting only as PVTT without a demonstrable parenchyma tumour. The clinicopathological and biological features of PVTT-HCC are not clear.
The data for patients who had PVTT-HCC with histologically confirmed HCC from January 2004 to December 2012 at the Eastern Hepatobiliary Surgery Hospital were retrospectively analysed. The survival outcomes of patients with PVTT-HCC were compared with those of HCC patients with PVTT (HCC-PVTT). Propensity score matching (PSM) analysis was performed to match patients at a ratio of 1:3. Then, we performed RNA-Seq analysis of liver samples from PVTT-HCC and HCC-PVTT patients to identify and compare differentially expressed genes and biological pathways between the two groups.
We observed and collected 10 rare cases of PVTT-HCC and performed a prospective cohort study to compare overall survival (OS) between PVTT-HCC and HCC-PVTT. PVTT invaded the main portal vein in 10 PVTT-HCC patients. Univariate and multivariate analyses demonstrated that ChildPugh (A/B), different treatments (LR/non-LR), and different groups were independent risk factors for OS. The median OS was 10.3 months (95 % CI = 6.7-13.8) in the HCC-PVTT group and 7.5 months (95 % CI = 2.8-12.1) in the PVTT-HCC group (P = 0.042). From RNA-Seq, 1630 differentially expressed genes were obtained, of which 731 were upregulated and 899 downregulated in PVTT-HCC compared with HCC-PVTT.
The survival outcomes of patients with PVTT-HCC were worse than those of patients with HCC-PVTT. RNA-Seq demonstrated differential gene expression between PVTT-HCC and HCC-PVTT, indicating that the former may have distinguishing biological characteristics and be a new and rare type of HCC.
肝细胞癌（HCC）患者的门静脉肿瘤血栓（PVTT）是一种与生存不良相关的主要并发症。我们在一小群仅表现为PVTT而无明显实质肿瘤的HCC患者中，临床定义了一种新的罕见类型的HCC，即PVTT型HCC（PVTT-HCC）。PVTT-HCC的临床病理和生物学特征尚不清楚。
回顾性分析2004年1月至2012年12月在东方肝胆外科医院经组织学证实为HCC的PVTT-HCC患者的数据。将PVTT-HCC患者的生存结果与伴有PVTT的HCC患者（HCC-PVTT）的生存结果进行比较。进行倾向评分匹配（PSM）分析，以1:3的比例匹配患者。然后，我们对PVTT-HCC和HCC-PVTT患者的肝脏样本进行RNA测序分析，以鉴定和比较两组之间差异表达的基因和生物学途径。
我们观察并收集了10例罕见的PVTT-HCC病例，并进行了一项前瞻性队列研究，以比较PVTT-HCC和HCC-PVTT之间的总生存期（OS）。10例PVTT-HCC患者的PVTT侵犯了门静脉主干。单因素和多因素分析表明，Child-Pugh（A/B）、不同治疗方法（LR/非LR）和不同组是OS的独立危险因素。HCC-PVTT组的中位OS为10.3个月（95%CI = 6.7-13.8），PVTT-HCC组为7.5个月（95%CI = 2.8-12.1）（P = 0.042）。通过RNA测序，获得了1630个差异表达基因，其中与HCC-PVTT相比，PVTT-HCC中有731个上调，899个下调。
PVTT-HCC患者的生存结果比HCC-PVTT患者更差。RNA测序显示PVTT-HCC和HCC-PVTT之间存在差异基因表达，表明前者可能具有独特的生物学特征，是一种新的罕见类型的HCC。
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