The Prognostic Comparison Between Hepatocellular Carcinoma with Portal Vein Tumor Thrombus and Bile Duct Cancer Thrombus After Liver Resection.
The Prognostic Comparison Between Hepatocellular Carcinoma with Portal Vein Tumor Thrombus and Bile Duct Cancer Thrombus After Liver Resection.
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肝细胞癌伴门静脉癌栓与胆管癌栓肝切除术后的预后比较
DOI：
10.2147/cmar.s278777
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发表时间：
2020
影响因子：
3.3
通讯作者：
Zhang JB
中科院分区：
文献类型：
--
作者：
Yang X;Zhu Y;Zhao X;Li JH;Xu D;Jia HL;Zhang JB
背景与目的肝细胞癌（HCC）常侵袭门静脉及其分支形成门静脉肿瘤血栓（PVTT），很少向胆管扩散形成胆管肿瘤血栓（BDTT）。然而，两类肿瘤血栓患者的临床预后是不同的。在本文中，我们计划比较PVTT和BDTT对HCC的预后，以便进一步的临床治疗。患者与方法共纳入60例患者，其中48例HCC合并PVTT， 12例HCC合并BDTT。从参与者那里收集了医疗记录。随访时间为肝切除术后3年。通过统计学分析探讨肿瘤血栓与临床病理特征的关系，确定术前影响总生存期（OS）和复发时间（TTR）的重要因素，建立生存与复发曲线。结果HCC合并BDTT或PVTT常合并病毒性乙型肝炎，伴不同程度肝硬化，甲胎蛋白高（68.3%），肿瘤包膜完整（76.7%），肿瘤体积较大（85.0%）。此外，HCC和BDTT患者的总胆红素（TB）更高，淋巴结转移的可能性更大。多因素Cox风险分析也显示，肿瘤大小和肿瘤血栓均可作为HCC患者的独立预后指标。生存曲线显示，BDTT HCC患者的1年、2年和3年OS或DFS率分别显著低于PVTT HCC患者。结论肿瘤血栓是HCC患者生存率低、复发率高的独立危险因素。与PVTT患者相比，BDTT HCC患者总生存期较短，肿瘤复发率较高。
Background and Objective Hepatocellular carcinoma (HCC) often invades the portal vein and its branches to form portal vein tumor thrombus (PVTT), and it rarely spreads into the bile ducts to cause bile duct tumor thrombus (BDTT). However, the clinical prognosis of patients with the two types of tumor thrombus is different. In this manuscript, we plan to compare the prognosis of HCC with PVTT and BDTT for further clinical treatment. Patients and Methods A total of 60 patients including 48 HCC cases with PVTT and 12 HCC cases with BDTT were enrolled in the study. The medical records were collected from participants. The follow-up was performed in 3 years post-hepatectomy. Statistical analysis was performed to explore the relationship between tumor thrombus with clinicopathological characteristics, to determine the significant preoperative factors influencing overall survival (OS) and time to recurrence (TTR), and to establish the survival and recurrent curves. Results HCC with BDTT or PVTT often combined with viral hepatitis B, accompanied by varying degrees of cirrhosis, and high AFP level (68.3%), complete tumor capsule (76.7%), and larger tumor size (85.0%). Furtherly, patients with HCC and BDTT tended to have higher total bilirubin (TB) and more possibility of lymph node metastases. The multivariate Cox hazard analyses also revealed that both tumor size and tumor thrombus could be taken as independent prognostic indicators of HCC patients. Survival curves showed that the 1-, 2- and 3-year OS or DFS rates of HCC patients with BDTT were significantly lower than those of HCC patients with PVTT, respectively. Conclusion Tumor thrombus is an independent risk factor for poor survival and high recurrence in HCC. HCC patients with BDTT had shorter overall survival and higher tumor recurrence rate compared to HCC patients with PVTT.