Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Gut Liver. 2024 Jan 15;18(1):156-164. doi: 10.5009/gnl230057. Epub 2023 Nov 28.
BACKGROUND/AIMS: : This study aimed to assess whether hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) could have favorable prognoses with proper treatment under selective conditions.
: This retrospective, single-center study involved 1,168 patients diagnosed with HCC between January 2005 and December 2006, before the introduction of sorafenib. Overall survival (OS) was estimated using the Kaplan-Meier method, and the Cox proportional hazards model was used to identify and adjust the variables associated with OS.
: In nodular-type HCC, the OS differed significantly according to the presence of PVTT (log-rank p<0.001), and the level of PVTT, not only its presence, was a major independent factor affecting OS. PVTT at the Vp1-3 branch was associated with significantly longer OS than was PVTT at the Vp4 level (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.04 to 3.21). In multivariate analysis, the OS was further stratified according to the PVTT level and tumor type, representing that nodular HCC without PVTT exhibited the best OS, whereas nodular HCC with Vp4 PVTT (adjusted HR, 2.59; 95% CI, 1.57 to 4.28) showed a poor prognosis similar to that of infiltrative HCC. The PVTT level was consistently correlated with OS in patients treated with transarterial chemoembolization. Nodular HCC without PVTT showed the best prognosis, while nodular HCC with Vp1-3 PVTT also exhibited a favorable OS, although inferior to that without PVTT (adjusted HR, 1.47, 95% CI, 0.92 to 2.36).
: Active treatment such as transarterial chemoembolization can be considered for selected PVTT cases. The level of PVTT and type of HCC were independent prognostic factors.
背景/目的：本研究旨在评估在选择性条件下，经适当治疗后，伴有门静脉癌栓（PVTT）的肝细胞癌（HCC）患者是否能获得较好的预后。
本回顾性、单中心研究纳入了 2005 年 1 月至 2006 年 12 月在索拉非尼问世前诊断为 HCC 的 1168 例患者。采用 Kaplan-Meier 法估计总生存期（OS），并采用 Cox 比例风险模型识别和调整与 OS 相关的变量。
在结节型 HCC 中，是否存在 PVTT 显著影响 OS（对数秩检验 p<0.001），而且不仅仅是 PVTT 的存在，而是其严重程度是影响 OS 的主要独立因素。与 Vp4 水平的 PVTT 相比，Vp1-3 分支的 PVTT 与显著更长的 OS 相关（风险比[HR]，1.82；95%置信区间[CI]，1.04 至 3.21）。在多变量分析中，根据 PVTT 水平和肿瘤类型对 OS 进一步分层，结果表明无 PVTT 的结节型 HCC 具有最佳的 OS，而伴有 Vp4 PVTT 的结节型 HCC（调整 HR，2.59；95%CI，1.57 至 4.28）的预后与浸润型 HCC 相似较差。PVTT 水平与经肝动脉化疗栓塞治疗的患者的 OS 始终相关。无 PVTT 的结节型 HCC 显示出最佳的预后，而伴有 Vp1-3 PVTT 的结节型 HCC 也显示出较好的 OS，尽管不如无 PVTT 的患者（调整 HR，1.47，95%CI，0.92 至 2.36）。
对于选择的 PVTT 病例，可以考虑积极治疗，如经肝动脉化疗栓塞术。PVTT 水平和 HCC 类型是独立的预后因素。
