手术切除及经门静脉免疫化疗治疗肝细胞癌合并门静脉癌栓

A combination surgery and intraportal vein immunochemotherapy in the treatment of hepatocellular carcinoma with portal veinous tumor thrombi

目的评估对肝癌合并门静脉癌栓患者实施手术切除联合术后门静脉化疗加免疫治疗的临床效果。方法采用随机化前瞻性临床试验方案,选取术后确诊为肝癌合并门静脉主干及第一级分支癌栓患者随机纳入研究组和对照组,行肿瘤切除+癌栓取出术,研究组术后经门静脉途径行PIAF(5-FU、阿霉素、顺铂,α-IFN)方案化疗,对照组术后仅行常规治疗。随访观察复发或转移情况,进行统计分析。结果研究组与对照组比较,研究组中位生存时间较对照组明显延长(12．5个月vs．7．0个月,P=0．0073);Cox多因素分析显示治疗方法选择(是否化疗)是影响患者生存率的独立预后因素。研究组肿瘤中位复发时间较对照组延长(7．0个月vs．3．0个月,P=0．0089);Cox多因素分析表明仅治疗方案的不同(手术后化疗与否)和AFP值对患者的复发有显著影响(P<0．05)。结论HCC合并PVTT患者,行肿瘤切除+癌栓取出术,手术后辅以经门静脉+皮下的PIAF免疫化疗是有效治疗HCC合并PVTT患者的综合疗法。

Objective To evaluate the effect of tumor resection in combination with prophylactic immuno-chemotherapy in hepatocellular carcinoma （HCC） patients with portal veinous tumor thrombi （PVTT）. Methods Postoperative HCC patients with identified PVTF within portal trunk or the first branch were randomized into research group and control group by envelope method. The research group received postoperative chemotherapy consisted of PIAF （5-FU ＋ Adrlamycin ＋ cisplatin ＋ α-IFN ）, while patients in the control group did not receive chemotherapy. Data were analyzed with SPSS 11.5. Result The median survival time in patients of research group was significantly longer than that in control group （ 12. 5 m vs. 7.0 m, P = 0. 0073 ）. Multivariate analysis showed the treatment variables was independent predictors of survival （ P = 0. 036 ）. The median tumor relapse time were longer in the research group compared with the control （ 7.0 m vs. 3.0 m, P = 0. 0089 ）. Multivariate analysis showed the treatment variables and preoperative AFP level were predictors of relapse （P = 0. 038 and 0. 014, respectively）. Conclusions Tumor resection plus tumor embolectomy with postoperative intraportal vein immumo- chemotherapy is an effective therapy for HCC patients with PVTF.