Resection of Hepatocellular Carcinoma with Macroscopic Vascular Invasion
Resection of Hepatocellular Carcinoma with Macroscopic Vascular Invasion
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DOI：
10.1245/s10434-013-3074-7
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发表时间：
2013-11-01
影响因子：
3.7
通讯作者：
Schwartz, Myron
中科院分区：
文献类型：
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作者：
Roayaie, Sasan;Jibara, Ghalib;Schwartz, Myron
据报道，患有肝细胞癌（HCC）和肉眼可见血管浸润（MVI）的Child A患者的生存期约为8.1个月。手术在这些患者中的作用仍然存在争议。我们回顾了在一个中心接受肝细胞癌切除术的所有患者的记录。仅纳入经病理证实的MVI患者。切除术的入选标准要求有Child's A肝病，无临床门静脉高压症（2002年以后），无肝外疾病。肠系膜上上级静脉和门静脉的分支必须是开放的。我们确定了165例MVI患者在1992年6月至2010年3月期间接受肝切除术。中位随访时间为11.9个月，127例死亡，包括12例（7.3%）围手术期死亡。中位生存期和5年生存期分别为13.1个月和14%。多变量分析发现，甲胎蛋白（AFP）> 30 ng/ml（风险比2.07）、肿瘤大小> 7 cm（风险比1.59）和血管浸润程度（风险比1.74）与生存率独立相关。那些侵犯肝静脉或腔静脉的患者的中位生存期仅为4.7个月，MVI切除HCC的结果仍然有些令人失望，但优于同类患者的药物治疗。肿瘤大小、甲胎蛋白和血管侵犯程度可以帮助选择那些从肝切除术中获益最多的患者。由于结果不佳，肝静脉或腔静脉受累患者的切除可能不合理。
Survival for Child's A patients with hepatocellular cancer (HCC) and macroscopic vascular invasion (MVI) has been reported as approximately 8.1 months with sorafenib. The role of surgery for these patients remains controversial.The records of all patients undergoing resection of HCC at a single center were reviewed. Only patients with pathologically proven MVI were included. Inclusion criteria for resection required Child's A liver disease, no clinical portal hypertension (after 2002), and no extrahepatic disease. The superior mesenteric vein and portal vein branch to the remaining lobe had to be patent.We identified 165 patients with MVI treated with hepatic resection between June 1992 and March 2010. Median follow-up was 11.9 months with 127 deaths, including 12 (7.3 %) perioperative mortalities. Median and 5-year survivals were 13.1 months and 14 %. Multivariate analysis found alpha-fetoprotein (AFP) > 30 ng/ml (hazard ratio 2.07), tumor size > 7 cm (hazard ratio 1.59), and extent of vascular invasion (hazard ratio 1.74) to be independently associated with survival. Those with invasion of hepatic veins or vena cava had a median survival of only 4.7 months.The results for resection of HCC with MVI remain somewhat disappointing but are better than what is reported with medical therapy in similar patients. Tumor size, AFP, and extent of vascular invasion can help select those that will benefit most from hepatic resection. Resection of patients with hepatic vein or vena cava involvement may not be justified, given such poor results.