Hepatectomy after down-staging of hepatocellular carcinoma with portal vein tumor thrombus using chemoradiotherapy: A retrospective cohort study
Hepatectomy after down-staging of hepatocellular carcinoma with portal vein tumor thrombus using chemoradiotherapy: A retrospective cohort study
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DOI：
10.1016/j.ijsu.2017.06.082
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发表时间：
2017-08-01
影响因子：
15.3
通讯作者：
Ohdan, Hideki
中科院分区：
文献类型：
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作者：
Hamaoka, Michinori;Kobayashi, Tsuyoshi;Ohdan, Hideki
背景：本研究旨在探讨三维适形放射治疗(3D-CRT)联合肝动脉化疗(HAIC)联合三维适形放射治疗(3D-CRT)治疗门静脉主干癌栓(PVTT)和肝动脉插管化疗(HAIC)治疗不能手术切除的晚期肝癌患者的生存效益和安全性。如果根据放射学结果，所有肉眼病变都被认为是可切除的，就可以进行肝切除术。比较肝切除组(n=7)和未切除组(n=43)的总生存率(OS)。多因素分析结果显示，中转手术(风险比0.35；95%可信区间0.10e0.99；P=0.048)是影响OS的独立因素。术后无严重并发症发生，无死亡病例。结论：3D-CRT联合HAIC治疗晚期肝癌安全可靠，远期疗效良好。(C)2017 ijs出版集团有限公司。爱思唯尔有限公司出版。保留所有权利。
Background: This study evaluates the survival benefit and safety of hepatectomy after down-staging by 3-dimensional conformal radiation therapy (3D-CRT) for major portal vein tumor thrombus (PVTT) combined with hepatic arterial infusion chemotherapy (HAIC) for advanced hepatocellular carcinoma (HCC).Methods: Fifty-two patients with unresectable advanced HCC treated with HAIC combined with 3D-CRT for PVTT, from January 2002 to March 2015, were analyzed in this retrospective study. Hepatectomy was offered to patients if, based on radiologic findings, all gross lesions were considered resectable. The safety of hepatectomy was investigated and overall survival (OS) was compared between the resection group (n = 7) and non-resection group (n = 43). Results: OS was significantly higher in the resection group than in the non-resection group.Results of multivariate analysis identified conversion to surgery (hazard ratio, 0.35; 95% confidence interval, 0.10 e0.99; P = 0.048) as an independent factor influencing OS. There were no serious postoperative complications and no case of mortality in patients who underwent hepatectomy.Conclusions: Our findings suggest that hepatectomy after down-staging by 3D-CRT for PVTT combined with HAIC for advanced HCC is safe and results in good long term outcome. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.