Induction of Tumor Growth After Preoperative Portal Vein Embolization: Is It a Real Problem?
Induction of Tumor Growth After Preoperative Portal Vein Embolization: Is It a Real Problem?
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DOI：
10.1245/s10434-008-0222-6
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发表时间：
2009-02-01
影响因子：
3.7
通讯作者：
van Gulik, Thomas M.
中科院分区：
文献类型：
--
作者：
de Graaf, Wilmar;van den Esschert, Jacomina W.;van Gulik, Thomas M.
尽管术前门静脉栓塞术(PVE)是增加未来残肝(FRL)容量的有效手段，但关于可能的不良反应的报道很少。本文讨论了PVE对栓塞和非栓塞型肝叶肿瘤生长的影响的临床和实验证据，以及控制PVE后肿瘤进展的可能策略。使用MEDLINE进行文献综述，检索与PVE、门静脉结扎(PVL)和肿瘤生长相关的实验和临床研究的关键词。还检查了交叉参考文献和综述中的参考文献。临床和实验数据表明，术前肝动脉栓塞区和非栓塞区PVE后，肿瘤会发生进展。临床证据表明，结直肠转移或原发性肝肿瘤患者可能的肿瘤进展是基于小样本量研究。尽管多项研究证实了肿瘤的进展，但关于PVE直接增加肿瘤生长率的证据是间接的。PVE后影响肿瘤生长的可能机制有三种，即细胞因子或生长因子的变化、肝脏血供的改变以及增强的细胞宿主反应促进局部肿瘤的生长。PVE后化疗和PVE前序贯经导管肝动脉化疗栓塞术(TACE)可以减少PVE后的肿瘤质量。我们的结论是，无论是结直肠癌转移患者还是原发性肝肿瘤患者，PVE后肿瘤的进展都可能发生。然而，还需要进一步的研究来评估PVE后肿瘤进展的风险。
Although preoperative portal vein embolization (PVE) is an effective means to increase future remnant liver (FRL) volume, little has been published on possible adverse effects. This review discusses the clinical and experimental evidence regarding the effect of PVE on tumor growth in both embolized and nonembolized liver lobes, as well as potential strategies to control tumor progression after PVE. A literature review was performed using MEDLINE with keywords related to experimental and clinical studies concerning PVE, portal vein ligation (PVL), and tumor growth. Cross-references and references from reviews were also checked. Clinical and experimental data suggest that tumor progression can occur after preoperative PVE in embolized and nonembolized liver segments. Clinical evidence indicating possible tumor progression in patients with colorectal metastases or with primary liver tumors is based on studies with small sample size. Although multiple studies demonstrated tumor progression, evidence concerning a direct increase in tumor growth rate as a result of PVE is circumstantial. Three possible mechanisms influencing tumor growth after PVE can be recognized, namely changes in cytokines or growth factors, alteration in hepatic blood supply and an enhanced cellular host response promoting local tumor growth after PVE. Post-PVE chemotherapy and sequential transcatheter arterial chemoembolization (TACE) before PVE have been proposed to reduce tumor mass after PVE. We conclude that tumor progression can occur after PVE in patients with colorectal metastases as well as in patients with primary liver tumors. However, further research is needed in order to rate this risk of tumor progression after PVE.