Is disease progression a contraindication for the strategy of portal vein embolization followed by hepatectomy for hepatocellular carcinoma?
Is disease progression a contraindication for the strategy of portal vein embolization followed by hepatectomy for hepatocellular carcinoma?
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DOI：
10.1016/j.surg.2018.10.023
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发表时间：
2019-04-01
期刊：
影响因子：
3.8
通讯作者：
Baba, Hideo
中科院分区：
文献类型：
--
作者：
Imai, Katsunori;Yamashita, Yo-ichi;Baba, Hideo
背景：门静脉栓塞术已在世界范围内被用于诱导未来肝残体肥厚和降低肝切除术后肝功能不全和死亡的风险。然而，门静脉栓塞后的疾病进展是否会影响肝细胞癌患者的长期肿瘤预后尚不确定。方法：从2000年至2016年间接受门静脉栓塞并随后进行肝切除术的107例患者中，纳入57例肝细胞癌患者。我们评估了他们的长期肿瘤预后，并调查了门静脉栓塞和随后的肝切除术之间的疾病进展是否影响生存。结果：肝切除术后5年总生存率为74.5%，无病生存率为31.7%。多因素分析显示，肝切除术前肿瘤数>= 3（危险比3.59，P= 0.019）、去γ -羧基凝血酶原>200 mAU/mL（危险比3.36，P= 0.045）、红细胞输注（危险比11.03，P= 0.0008）是影响总生存的独立预后因素。男性（风险比3.74，P= 0.029）、双叶肿瘤分布（风险比3.65，P= 0.004）和红细胞输注（风险比6.22，P= 0.0026）是影响无病生存的独立预后因素。门静脉栓塞后的疾病进展，包括肿瘤大小、肿瘤数量、甲胎蛋白、甲胎蛋白凝集素反应分数和去γ -羧基凝血酶原的增加，分别在22.8%、14.0%、29.8%、19.3%和47.4%的患者中观察到。在单变量分析中，只有肿瘤数量的增加显著降低了肝切除术后的无病生存率，没有任何变量影响总生存率。结论：门静脉栓塞后的疾病进展不会影响肝细胞癌患者的长期生存，如果能够完成计划的后续肝切除术。(C) 2018爱思唯尔公司版权所有。
Background: Portal vein embolization has been used worldwide to induce hypertrophy of the future liver remnant and to reduce the risk of hepatic insufficiency and death after major hepatectomy. However, whether disease progression after portal vein embolization can affect long-term oncologic outcomes in patients with hepatocellular carcinoma is uncertain.Methods: From a total of 107 patients who underwent portal vein embolization and subsequent hepatectomy between 2000 and 2016, 57 patients with hepatocellular carcinoma were enrolled. We evaluated their long-term oncologic outcomes and investigated whether the disease progression between portal vein embolization and subsequent hepatectomy affected survival.Results: The 5-year overall survival and disease-free survival after hepatectomy were 74.5% and 31.7%, respectively. Multivariate analyses revealed that tumor number before hepatectomy >= 3 (hazard ratio 3.59, P = .019), des-gamma-carboxy prothrombin >200 mAU/mL (hazard ratio 3.36, P = .045), and red blood cell transfusion (hazard ratio 11.03, P=.0008) were independent prognostic factors for overall survival. Male sex (hazard ratio 3.74, P = .029), bilobar tumor distribution (hazard ratio 3.65, P = .004), and red blood cell transfusion (hazard ratio 6.22, P=.0026) were independent prognostic factors for disease-free survival. Disease progressions after portal vein embolization, including increases in tumor size, tumor number, alpha-fetoprotein, lens culinaris agglutinin-reactive fraction of alpha-fetoprotein, and des-gamma-carboxy prothrombin, were observed in 22.8%, 14.0%, 29.8%, 19.3%, and 47.4% of patients, respectively. Only an increase of tumor number significantly decreased the disease-free survival rate after hepatectomy in a univariate analysis, and none of the variables affected overall survival.Conclusion: Disease progression after portal vein embolization did not affect long-term survival in patients with hepatocellular carcinoma if the planned subsequent hepatectomy could be completed. (C) 2018 Elsevier Inc. All rights reserved.