A new classification for hepatocellular carcinoma with portal vein tumor thrombus
A new classification for hepatocellular carcinoma with portal vein tumor thrombus
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DOI：
10.1007/s00534-010-0314-0
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发表时间：
2011-01-01
影响因子：
3
通讯作者：
Cheng, Shu-Qun
中科院分区：
文献类型：
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作者：
Shi, Jie;Lai, Eric C. H.;Cheng, Shu-Qun
我们的目的是将肝细胞癌（HCC）伴肉眼门静脉癌栓（PVTT）患者接受部分肝切除术伴或不伴门静脉癌栓切除术的生存率与我们的PVTT分类相关联。目前，临床实践中广泛使用不同的肝癌分期系统。然而，一旦出现肉眼可见的门静脉血栓形成，他们在提供预后和指导手术治疗方面缺乏精确性。我们在一个三级中心进行了一项回顾性研究，从2001年1月至2004年12月，对441例因肉眼可见的门静脉血栓形成而接受部分肝切除术或不接受门静脉血栓切除术的HCC患者进行了回顾性研究。检查总生存期以确定其是否与我们的PVTT分类、TNM分期、意大利肝癌计划（CLIP）评分系统和日本综合分期（JIS）评分系统相关。I型、II型、III型和IV型PVTT患者分别为144例（32.7%）、189例（42.9%）、86例（19.5%）和22例（5.0%）。I型至IV型PVTT相应的1年、2年和3年总生存率分别为54.8、33.9和26.7%; 36.4、24.9和16.9%; 25.9、12.9和3.7%;以及11.1、0和0%（生存曲线的对数秩P < 0.0001）。使用TNM系统，大多数患者被归类为III期（n = 379或85.9%）。同样，大多数患者（n = 388或88.0%）的CLIP评分为2分（n = 143或32.4%）、3分（n = 171或38.8%）和4分（n = 74或16.8%）。这3种CLIP评分的1年、2年和3年总生存率非常相似。使用JIS评分，大多数患者（n = 372或84.4%）的JIS评分为2。JIS评分为2的患者的1年、2年和3年总生存率比JIS评分为1的患者差（这是预期的），也比JIS评分为3的患者差（这是非预期的）。因此，后3个分类系统不够精细，不足以对经部分肝切除术联合或不联合血栓切除术治疗的肉眼可见PVTT的HCC进行分层。在经部分肝切除术联合或不联合血栓切除术治疗的肉眼可见PVTT的HCC患者中，我们的PVTT分类比TNM分期、CLIP评分系统和JIS评分系统更好地分层和预测预后，这是不完善的，不适合这组病人。
We aimed to correlate the survival of patients with hepatocellular carcinoma (HCC) with macroscopic portal vein tumor thrombus (PVTT) who underwent partial hepatectomy with or without portal thrombectomy with our PVTT classification. Currently, different staging systems for HCC are widely used in clinical practice. However, they lack the refinement in giving prognosis and guiding surgical treatment once macroscopic PVTT is present.A retrospective study was carried out, in a single tertiary center, from January 2001 to December 2004 on 441 patients who underwent partial hepatectomy with or without portal thrombectomy for HCC with macroscopic PVTT. Overall survival was examined to determine whether it was correlated with our PVTT classification, and with the TNM staging, Cancer of the Liver Italian Program (CLIP) scoring system, and the Japan Integrated Staging (JIS) scoring system.With our PVTT classification, the numbers (percentages) of patients with types I, II, III, and IV PVTT were 144 (32.7%), 189 (42.9%), 86 (19.5%), and 22 (5.0%), respectively. The corresponding 1-, 2-, and 3-year overall survival rates for types I to IV PVTT were 54.8, 33.9, and 26.7%; 36.4, 24.9, and 16.9%; 25.9, 12.9, and 3.7%; and 11.1, 0, and 0%, respectively (log-rank of the survival curves P < 0.0001). Using the TNM system, the majority of patients were classified as stage III (n = 379 or 85.9%). Similarly, the majority of patients (n = 388 or 88.0%) were classified as having CLIP scores of 2 (n = 143, or 32.4%), 3 (n = 171, or 38.8%), and 4 (n = 74, or 16.8%). The 1-, 2-, and 3-year overall survivals for these 3 CLIP scores were very similar. Using the JIS score, the majority of patients (n = 372 or 84.4%) were classified with a JIS score of 2. The 1-, 2-, and 3-year overall survivals of patients with a JIS score of 2 were worse than those of the patients with a JIS score of 1 (this was expected) as well as being worse than those with a JIS score of 3 (this was unexpected). Thus, the latter 3 systems of classification were not refined enough, and they were inadequate for stratifying HCC with macroscopic PVTT treated with partial hepatectomy with or without thrombectomy.In patients with HCC with macroscopic PVTT treated by partial hepatectomy with or without thrombectomy, our PVTT classification better stratified and predicted prognosis than the TNM staging, CLIP scoring system, and JIS scoring system, which were unrefined and inadequate for this group of patients.