Surgical treatment of hepatocellular carcinoma associated with hepatic vein tumor thrombosis
Surgical treatment of hepatocellular carcinoma associated with hepatic vein tumor thrombosis
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DOI：
10.1016/j.jhep.2014.04.032
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发表时间：
2014-09-01
影响因子：
25.7
通讯作者：
Kokudo, Norihiro
中科院分区：
文献类型：
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作者：
Kokudo, Takashi;Hasegawa, Kiyoshi;Kokudo, Norihiro
背景和目标：肝静脉肿瘤血栓（HVTT）在肝细胞癌（HCC）患者中的存在被认为是预后极差的信号。然而，鲜为人知的是手术治疗的预后影响HVTT.Methods：我们的数据库手术切除肝癌1994年10月至2011年12月在日本三级医院进行了回顾性分析。我们统计学比较了HCC患者外周肝静脉肿瘤血栓形成的患者特征和手术结局，包括显微镜下浸润（pHVTT）、主要肝静脉肿瘤血栓形成（mHVTT）和下腔静脉肿瘤血栓形成（IVCTT）。结果：pHVTT组和mHVTT组的中位生存时间（MST）分别为5.27和3.95年（p = 0.77），中位复发时间（TTR）分别为1.06和0.41年（p = 0.74）。另一方面，IVCTT患者组的MST和TTR分别为1.39年和0.25年;此外，Child-Pugh B级患者的MST显著更差（2.39 vs. 0.44年，p = 0.0001）。多因素分析显示IVCTT（风险比[RR] 2.54，p = 0.024）和R1/2切除（RR 2.08，p = 0.017）作为总生存率的危险因素。结论：肝切除术提供了可接受的结果时，R 0切除术是可行的mHVTT或pHVTT肝癌患者。在肝功能良好的情况下，即使是IVCTT患者也可以尝试切除HCC。(C)2014年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background & Aims: Presence of hepatic vein tumor thrombosis (HVTT) in patients with hepatocellular carcinoma (HCC) is regarded as signaling an extremely poor prognosis. However, little is known about the prognostic impact of surgical treatment for HVTT.Methods: Our database of surgical resection for HCC between October 1994 and December 2011 in a tertiary care Japanese hospital was retrospectively analysed. We statistically compared the patient characteristics and surgical outcomes in HCC patients with tumor thrombosis in a peripheral hepatic vein, including microscopic invasion (pHVTT), tumor thrombosis in a major hepatic vein (mHVTT), and tumor thrombosis of the inferior vena cava (IVCTT). Among 1525 hepatic resections, 153 cases of pHVTT, 21 cases of mHVTT, and 13 cases of IVCTT were identified.Results: The median survival time (MST) in the pHVTT and mHVTT groups was 5.27 and 3.95 years, respectively (p = 0.77), and the median time to recurrence (TTR) was 1.06 and 0.41 years, respectively (p = 0.74). On the other hand, the MST and TTR in the patient group with IVCTT were 1.39 years and 0.25 year respectively; furthermore, the MST of Child-Pugh class B patients was significantly worse (2.39 vs. 0.44 years, p = 0.0001). Multivariate analyses revealed IVCTT (risk ratio [RR] 2.54, p = 0.024) and R 1/2 resection (RR 2.08, p = 0.017) as risk factors for the overall survival.Conclusions: Hepatic resection provided acceptable outcomes in HCC patients with mHVTT or pHVTT when R0 resection was feasible. Resection of HCC may be attempted even in patients with IVCTT, in the presence of good liver function. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.