Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy for Unresectable Hepatitis B Virus-related Hepatocellular Carcinoma A Single Center Study of 45 Patients
Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy for Unresectable Hepatitis B Virus-related Hepatocellular Carcinoma A Single Center Study of 45 Patients
复制标题
将肝分区和门静脉结扎联合用于治疗不可切除的乙型肝炎病毒相关肝细胞癌的分期肝切除术：一项 45 名患者的单中心研究。
DOI：
10.1097/sla.0000000000002942
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发表时间：
2020-03-01
影响因子：
9
通讯作者：
Zhou, Jian
中科院分区：
文献类型：
--
作者：
Wang, Zheng;Peng, Yuanfei;Zhou, Jian
目的：本研究的目的是评估联合肝脏分割和门静脉结扎进行分期肝切除术（ALPPS）治疗B病毒相关肝细胞癌（HCC）患者的有效性和安全性。背景：ALPSS允许根治性切除常规不能切除的肝肿瘤。然而，它在HCC中的作用在很大程度上是未知的。方法：回顾性研究了2013年4月至2017年9月在我中心接受ALPPS的连续性HCC患者。采用倾向评分匹配（PSM）分析将肿瘤学结果与接受经导管动脉化疗栓塞（TACE）的患者和接受一期切除术的患者进行比较。结果如下：单发肿瘤患者（n = 28）的中位肿瘤直径为13 cm（范围：6-22 cm），而多发肿瘤患者（n = 17）的中位总肿瘤直径为12 cm（范围：9-31 cm）。在1期ALPPS后，中位未来肝脏残留（FLR）增加了56.8%。41例患者（91.1%）在中位12天后完成了2期ALPPS。90天死亡率为11.1%（5/45）。1年和3年的总生存率（OS）分别为64.2%和60.2%，而1年和3年的无病生存率（DFS）分别为47.6%和43.9%。PSM分析显示，ALPPS组患者的长期生存率明显优于TACE组（OS，P = 0.004; DFS，P < 0.0001），与一期肝切除组相似（OS，P = 0.514; DFS，P = 0.849）。结论：ALPPS术后远期生存率明显优于TACE，与一期肝切除术后的远期生存率相近。ALPPS是不可切除HCC患者的一种可行治疗选择。
Objective: The aim of the study is to assess the efficacy and safety of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in patients with hepatitis B virus-related hepatocellular carcinoma (HCC). Background: ALPSS allows curative resection of conventionally-unresectable liver tumors. However, its role in HCC is largely unknown. Methods: Consecutive HCC patients who underwent ALPPS at our center between April 2013 and September 2017 were retrospectively studied. The oncological results were compared with patients receiving transcatheter arterial chemoembolization (TACE), and patients undergoing one-stage resection by using propensity score matching (PSM) analysis. Results: The median tumor diameter was 13 cm (range: 6-22 cm) in patients with a single tumor (n = 28), whereas the median total tumor diameter was 12 cm (range: 9-31 cm) in patients with multiple tumors (n = 17). After stage-1 ALPPS, the median future liver remnant (FLR) increased by 56.8%. The stage-2 ALPPS was completed in 41 patients (91.1%) after a median of 12 days. The 90-day mortality rate was 11.1% (5/45). The overall survival (OS) rates at 1- and 3-year were 64.2% and 60.2%, whereas the disease-free survival (DFS) rates at 1 and 3 years were 47.6% and 43.9%, respectively. On PSM analysis, the long-term survival of patients undergoing ALPPS was significantly better than those receiving TACE (OS, P = 0.004; DFS, P < 0.0001) and similar to those subjected to one-stage liver resection (OS, P = 0.514; DFS, P = 0.849). Conclusions: The long-term survival after ALPPS was significantly better than TACE, and similar to those after one-stage liver resection. ALPPS is a viable treatment option for patients with unresectable HCC in selected patients.