Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion

被引：480

作者：

Kokudo, Takashi ^{[1
,2
]}

Hasegawa, Kiyoshi ^{[1
]}

Matsuyama, Yutaka ^{[3
]}

Takayama, Tadatoshi ^{[4
]}

Izumi, Namiki ^{[5
]}

Kadoya, Masumi ^{[6
]}

Kudo, Masatoshi ^{[7
]}

Ku, Yonson ^{[8
]}

Sakamoto, Michiie ^{[9
]}

Nakashima, Osamu ^{[10
]}

Kaneko, Shuichi ^{[11
]}

Kokudo, Norihiro ^{[1
]}

机构：

[1] Univ Tokyo, Grad Sch Med, Dept Surg, Hepatobiliary Pancreat Surg Div, Tokyo 1138654, Japan

[2] Saitama Canc Ctr, Div Gastroenterol Surg, Saitama, Japan

[3] Univ Tokyo, Sch Publ Hlth, Dept Biostat, Tokyo 1138654, Japan

[4] Nihon Univ, Sch Med, Dept Digest Surg, Tokyo 102, Japan

[5] Musashino Red Cross Hosp, Dept Gastroenterol, Musashino, Tokyo, Japan

[6] Shinshu Univ, Sch Med, Dept Radiol, Matsumoto, Nagano, Japan

[7] Kinki Univ, Sch Med, Dept Gastroenterol & Hepatol, Higashiosaka, Osaka 577, Japan

[8] Kobe Univ, Grad Sch Med, Dept Surg, Div HepatobiliaryPancreat Surg, Kobe, Hyogo, Japan

[9] Keio Univ, Dept Pathol, Sch Med, Tokyo 108, Japan

[10] Kurume Univ Hosp, Dept Clin Lab Med, Kurume, Fukuoka, Japan

[11] Kanazawa Univ Hosp, Dept Gastroenterol, Kanazawa, Ishikawa, Japan

来源：

JOURNAL OF HEPATOLOGY | 2016年 / 65卷 / 05期

关键词：

Hepatocellular carcinoma; Liver resection; Portal vein tumor thrombosis; Propensity score-match; Nationwide survey; HEPATIC RESECTION; TRANSARTERIAL CHEMOEMBOLIZATION; SURGICAL-TREATMENT; TUMOR THROMBUS; HEPATECTOMY; SORAFENIB; RADIOEMBOLIZATION; RECOMMENDATIONS; STRATIFICATION; THROMBECTOMY;

D O I：

10.1016/j.jhep.2016.05.044

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

100201 [内科学];

摘要：

Background & Aims: The presence of portal vein tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC) is regarded as indicating an advanced stage, and liver resection (LR) is not recommended. The aim of this study was to evaluate the survival benefit of LR for HCC patients with PVTT through the analysis of the data from a Japanese nationwide survey. Methods: We analyzed data for 6474 HCC patients with PVTT registered between 2000 and 2007. Of these patients, 2093 patients who underwent LR and 4381 patients who received other treatments were compared. The propensity scores were calculated and we successfully matched 1058 patients (66.1% of the LR group). Results: In the Child-Pugh A patients, the median survival time (MST) in the LR group was 1.77 years longer than that in the non-LR group (2.87 years vs. 1.10 years; p <0.001) and 0.88 years longer than that in the non-LR group (2.45 years vs. 1.57 years; p <0.001) in a propensity score-matched cohort. A subgroup analysis revealed that LR provides a survival benefit regardless of age, etiology of HCC, tumor marker elevation, and tumor number. The survival benefit was not statistically significant only in patients with PVTT invading the main trunk or contralateral branch. In the LR group, the postoperative 90-day mortality rate was 3.7% (68 patients). Conclusions: As long as the PVTT is limited to the first-order branch, LR is associated with a longer survival outcome than non-surgical treatment. Lay summary: The presence of portal vein tumor thrombosis in patients with hepatocellular carcinoma is regarded as indicating an advanced stage, and liver resection is not recommended. We performed a multicenter, nationwide study to assess the survival benefit of liver resection in hepatocellular carcinoma patients with portal vein tumor thrombosis using propensity score based matching. As long as the portal vein tumor thrombosis is limited to the first-order branch, liver resection is associated with a longer survival outcome than non-surgical treatment. (C) 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

引用

页码：938 / 943

页数：6

共 33 条

[1]

Effects of location and extension of portal vein tumor thrombus on long-term outcomes of surgical treatment for hepatocellular carcinoma [J].