An aggressive approach leads to improved survival in hepatocellular carcinoma patients with portal vein tumor thrombus.
An aggressive approach leads to improved survival in hepatocellular carcinoma patients with portal vein tumor thrombus.
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DOI：
10.1007/s00432-010-0868-x
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发表时间：
2011-01
影响因子：
3.6
通讯作者：
Li, Lin-Li
中科院分区：
文献类型：
--
作者：
Lin, De-Xin;Zhang, Qi-Yu;Li, Xuan;Ye, Qi-Wen;Lin, Fen;Li, Lin-Li
对于合并门静脉癌栓的肝细胞癌（HCC）的治疗，许多医生持相对虚无主义的态度。外科医生对积极入路的适应症尚未达成共识。目前的研究旨在确定扩大切除加血栓切除术和辅助治疗的积极方法是否会改善HCC伴PVTT患者的生存率。回顾性分析了1996年至2006年收治的116例肝癌伴PVTT患者。患者分为2个时间段（TP）队列，其中前5年（TP 1）51例，后5年（TP 2）65例。手术治疗68例。在TP 1中进行了21例手术切除，在TP 2中进行了47例手术切除。TP 2的肝切除范围和血栓切除率更高（P = 0.039）。在这两个时间段内，积极治疗与生存率改善相关（P < 0.02 TP 1，P < 0.001 TP 2）。TP 2组患者的总生存期显著高于TP 1组（P < 0.001），TP 2组的中位生存期为15个月，而TP 1组的中位生存期仅为9个月。TP 2的中位1年和3年生存率（分别为54%和34%）也高于TP 1（分别为31%和7%）。多因素Logistic回归分析显示，根治性切除和辅助治疗是总生存率的独立预测因素。一种积极的方法，结合扩大肝切除术与血栓切除术和辅助治疗，导致肝癌伴PVTT患者的生存率提高。
Many physicians express a relatively nihilistic approach to the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Consensus among surgeons regarding the indications for an aggressive approach has not been reached. Current study was aimed to determine whether an aggressive approach, with an extended resection with thrombectomy and adjuvant therapy, would lead to an improved survival for HCC patients with PVTT. A retrospective review of 116 HCC patients with PVTT admitted from 1996 to 2006 was conducted. Patients were divided into 2 time-period (TP) cohorts, of them, 51 cases in the first 5 years (TP1) and 65 in the last 5 years (TP2). Surgical operations were performed on 68 patients. Twenty-one surgical resections were performed in TP1 and forty-seven in TP2. The extent of liver resections, as well as the frequency of thrombectomy, was greater in TP2 (P = 0.039). During both time-periods, an aggressive therapy was associated with improved survival (P < 0.02 TP1, P < 0.001 TP2). Overall survival of all patients in TP2 was significantly greater than in TP1 (P < 0.001), with a median survival of 15 months in TP2, whereas in TP1, the survival was only 9 months. The median 1-, 3-year survivals in TP2 (54 and 34%, respectively) were also greater than that in TP1 (31 and 7%, respectively). A multiple logistic regression analysis revealed that radical resection and adjuvant therapy were the independent predictors of overall survival. An aggressive approach, combining extended liver resection with thrombectomy and adjuvant therapy, leads to an improved survival in the HCC patients with PVTT.
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影响因子：
5.2
作者：
Iwatsuki, S;Dvorchik, I;Starzl, TE
通讯作者：
Starzl, TE
影响因子：
13.5
作者：
Bruix, J;Llovet, JM
通讯作者：
Llovet, JM
影响因子：
5.2
作者：
Ohkubo, T;Yamamoto, J;Kosuge, T
通讯作者：
Kosuge, T
影响因子：
13.5
作者：
Llovet, JM;Bustamante, J;Bruix, J
通讯作者：
Bruix, J
辅助经导管动脉化疗栓塞术提高肝细胞癌合并门静脉癌栓患者肝切除术的疗效
影响因子：
3
作者：
Peng, Bao-Gang;He, Qiang;Zhou, Fan
通讯作者：
Zhou, Fan