Surgical Resection Is Preferred in Selected Solitary Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis.

IF 1.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Digestive Surgery Pub Date : 2022-01-01 Epub Date: 2022-01-11 DOI:10.1159/000521827

Jaehun Yang, Jong Man Kim, Jinsoo Rhu, Gyu-Seong Choi, Choon Hyuck David Kwon, Jae-Won Joh

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引用次数: 2

Abstract

Introduction: Sorafenib is the standard care for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT), though it offers limited survival. This study was designed to compare clinical outcomes between liver resection (surgery) and transarterial chemoembolization plus radiotherapy (TACE-RT) as the initial treatment modality for resectable treatment-naïve solitary HCC combined with subsegmental (Vp1), segmental (Vp2), and lobar (Vp3) PVTT.

Methods: From the institutional HCC registry, we identified 116 patients diagnosed with resectable treatment-naïve HCC with Vp1-Vp3 PVTT based on radiologic images who received surgery (n = 44) or TACE-RT (n = 72) as a primary treatment between 2010 and 2015. A propensity score matching (PSM) model was created.

Results: The TACE-RT group had a higher tumor burden (tumor size, extent, and markers) than the surgery group. Cumulative patient survival curve in the surgery group was significantly higher than that in the TACE-RT group before and after PSM. Liver function was relatively well preserved in the surgery group compared with the TACE-RT group. TACE-RT group, male, increased alkaline phosphatase, and increased platelet count were predisposing factors for patient death in resectable treatment-naïve solitary HCC with PVTT.

Discussion/conclusion: The present study suggests that surgery is considered as an initial treatment in selectively resectable treatment-naïve solitary HCC with Vp1-Vp3 PVTT.

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选择性单发肝细胞癌合并门静脉肿瘤血栓，首选手术切除。

索拉非尼(Sorafenib)是肝细胞癌(HCC)合并门静脉肿瘤血栓形成(PVTT)患者的标准治疗，尽管它的生存率有限。本研究旨在比较肝切除(手术)和经动脉化疗栓塞加放疗(TACE-RT)作为可切除的treatment-naïve孤立性HCC合并亚节段(Vp1)、节段(Vp2)和大叶(Vp3) PVTT的初始治疗方式的临床结果。方法:从机构HCC注册表中，我们确定了116例可切除的treatment-naïve HCC患者，根据放射图像诊断为Vp1-Vp3 PVTT，并在2010年至2015年期间接受手术(n = 44)或TACE-RT (n = 72)作为主要治疗。建立了倾向得分匹配(PSM)模型。结果:TACE-RT组肿瘤负荷(肿瘤大小、范围、标志物)高于手术组。PSM前后，手术组患者累积生存曲线明显高于TACE-RT组。与TACE-RT组相比，手术组肝功能保存相对较好。TACE-RT组、男性、碱性磷酸酶升高和血小板计数升高是可切除treatment-naïve孤立性HCC合并PVTT患者死亡的易感因素。讨论/结论:目前的研究表明，手术被认为是选择性切除treatment-naïve孤立性HCC伴Vp1-Vp3 PVTT的初始治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Surgery 医学-外科

CiteScore

4.90

自引率

3.70%

发文量

审稿时长

3 months

期刊介绍： ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.