Sequential transarterial chemoembolization and portal vein embolization before resection is a valid oncological strategy for unilobar hepatocellular carcinoma regardless of the tumor burden
Sequential transarterial chemoembolization and portal vein embolization before resection is a valid oncological strategy for unilobar hepatocellular carcinoma regardless of the tumor burden
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DOI：
10.1016/j.hpb.2016.05.012
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发表时间：
2016-08-01
期刊：
影响因子：
2.9
通讯作者：
Vilgrain, Valerie
中科院分区：
文献类型：
--
作者：
Ronot, Maxime;Cauchy, Francois;Vilgrain, Valerie
目的：探讨序贯经动脉化疗栓塞（TACE）和门静脉栓塞（PVE）的可切除性肝细胞癌（HCC）患者的长期肿瘤学结局。方法：根据是否按计划进行手术切除，对2006年至2012年所有肝大部切除前接受TACE-PVE的Child A HCC患者进行分析。结果：54例患者（50例）男性，93% 的中位年龄为 69 岁（范围 44-87））。 39 名 (72%) 患者接受了切除，其中 19/25、16/23 和 4/6 的 BCLC A、B 和 C 患者（p = 0.839）。 22 例 (56%) 出现肿瘤复发（中位延迟 10 个月），其中 9/19、11/16 和 2/4 的 BCLC A、B 和 C 患者出现复发（p = 0.430）。与未切除的患者相比，切除患者的生存率明显更高（中位总生存期 (OS)：44 个月与 18 个月；p < 0.001）。与未复发的患者相比，复发与较差的预后相关（中位 OS 43 个月与未达到；p < 0.001）。 BCLC 分期不影响生存（p = 0.13）。结论：对于大单叶 HCC 患者，TACE-PVE 导致大多数患者切除，无论肿瘤负荷如何，都具有良好的肿瘤学结果。当这种策略失败时，尽管之前有 PVE，但患者仍可以接受 TACE 治疗。
Objective: To investigate the long-term oncological outcome of patients with resectable hepatocellular carcinoma (HCC) undergoing sequential transarterial chemoembolization (TACE) and portal vein embolization (PVE).Methods: Analysis of all Child A HCC patients who underwent TACE-PVE before major liver resection from 2006 to 2012 was performed according to whether or not they underwent surgical resection as planned.Results: 54 patients (50 men, 93% median 69-years (range 44-87)) were included. Thirty-nine (72%) patients underwent resection, including 19/25, 16/23, and 4/6 of patients with BCLC A, B, and C (p = 0.839). Twenty-two (56%) had tumor recurrence (median delay 10 months) including 9/19, 11/16, and 2/4 of the patients with BCLC A, B, and C (p = 0.430). Survival was significantly better in resected patients as compared to those who were not resected (median overall survival (OS): 44 vs. 18 months; p < 0.001). Recurrence was associated with a poorer prognosis as compared to patients without recurrence (median OS 43 months vs. not reached; p < 0.001). BCLC stage did not influence survival (p = 0.13).Conclusion: In patients with large unilobar HCC, TACE-PVE leads to resection in most patients, with a good oncological outcome regardless of the tumor burden. When this strategy fails, patients can be managed with TACE despite prior PVE.