Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization
Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization
复制标题
DOI：
10.1053/jhep.2001.26513
复制
发表时间：
2001-08-01
期刊：
影响因子：
13.5
通讯作者：
Kato, Y
中科院分区：
文献类型：
--
作者：
Kokudo, N;Tada, K;Kato, Y
虽然半肝门静脉栓塞术（PVE）已被用于术前扩大结直肠转移患者的肝切除术的适应症，这种程序对肿瘤生长和结果的影响仍然存在争议。为了解决这个问题，我们评估了PVE后肝内转移瘤的增殖活性和该手术的长期结局。1996年至2000年间，18例结直肠转移患者接受了术前PVE（PVE组）。29例肝切除术后未行PVE的患者作为对照组（非PVE组）。PVE后3周，左叶的肝实质分数从38.1 +/- 3.2%显著增加至45.9 +/- 2.9%（+20.5%，P < .0001）。肿瘤体积和肿瘤体积百分比也分别从223 +/- 89 mL显著增加至270 +/- 97 mL（+20.8%，P = 0.016）和从13.7 +/- 4.3%显著增加至16.2 +/- 4.9%（+18.5%，P = 0.014）。实质体积的增加与肿瘤体积的增加之间没有明显的相关性。PVE组转移性病变的Ki-67标记指数为46.6 +/- 7.2%，非PVE组为35.4 +/- 12.6%（P = 0.013）。PVE组和非PVE组的长期生存率相似，但PVE组的无病生存率明显低于非PVE组（P = 0.004）。我们得出结论，PVE增加肿瘤生长，并可能与增强疾病复发。虽然PVE在扩大手术适应症方面是有效的，但PVE的患者选择应谨慎。
Although hemihepatic portal vein embolization (PVE) has been used preoperatively to extend indications for hepatectomy in patients with colorectal metastases, the effects of this procedure on tumor growth and outcome remain controversial. To address this issue, we assessed the proliferative activity of intrahepatic metastases after PVE and the long-term outcome of this procedure. Eighteen patients with colorectal metastases underwent preoperative PVE between 1996 and 2000 (PVE group). Twenty-nine patients who underwent major hepatic resection without PVE served as control (non-PVE group). The hepatic parenchymal fraction of the left lobe had significantly increased from 38.1 +/- 3.2% to 45.9 +/- 2.9% 3 weeks after PVE (+20.5%, P < .0001). Tumor volume and percent tumor volume had also significantly increased from 223 +/- 89 mL to 270 +/- 97 mL (+20.8%, P = .016) and from 13.7 +/- 4.3% to 16.2 +/- 4.9% (+18.5%, P = .014), respectively. There was no apparent correlation between the increase in parenchymal volume and that in tumor volume. The Ki-67 labeling index of metastatic lesions was 46.6 +/- 7.2% in the PVE group and 35.4 +/- 12.6% in the non-PVE group (P = .013). Long-term survival was similar in the PVE and non-PVE groups, however, disease-free survival was significantly poorer in the PVE group than in the non-PVE group (P = .004). We conclude that PVE increases tumor growth and probably is associated with enhanced recurrence of disease. Although PVE is effective in extending indications for surgery, patient selection for PVE should be cautious.