大肝癌伴门静脉癌栓病人综合疗法选择对照研究

Comparison of different combined modality therapy after surgical treatment of large primary liver cancer with portal vein tumor thrombus

目的分析大肝癌合并门静脉主干或一级分支癌栓病人行外科治疗并辅以不同综合治疗的疗效。方法回顾性分析2003年1月至2010年12月华中科技大学同济医学院附属同济医院经影像学检查或术中探查发现的87例大肝癌合并门静脉主干或一级分支癌栓病人的临床资料。根据术后主要抗肿瘤治疗方法的不同将病人分为3组:A组,行肝切除+门静脉取栓术;B组,行肝切除+门静脉取栓术,术中留置门静脉化疗泵,术后行灌注化疗;C组,行肝切除+门静脉取栓术,术后行肝动脉化疗栓塞。结果 A、B、C 3组的1年总体存活率分别为31.8%、44.7%和49.0%,2年总体存活率分别为12.7%、23.2%和27.2%,3年总体存活率分别为6.4%、11.6%和11.7%。生存分析显示:B组存活率高于A组(P=0.049),C组高于A组(P=0.033),而B组与C组间比较差异无统计学意义(P=0.751)。结论大肝癌合并门静脉主干或一级分支癌栓采用手术治疗同时术后行肝动脉化疗栓塞或门静脉灌注化疗的疗效优于单纯手术治疗,但对于癌栓累及门静脉主干的病人仍须慎重选择手术治疗。

Objective To study the value of surgical treatment for large primary liver cancer with portal vein tumor thrombus（PVTT） involving the main or first-order branches. Methods The clinical data of 87 large primary liver cancer patients with PVTT involving the main or first-order branches underwent hepatectomy and thrombectomy from January 2003 to December 2010 in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were analyzed retrospectively. The 87 patients were divided into 3 groups： group A only have hepatectomy and thrombectomy,group B have portal vein infusion chemotherapy after hepatectomy and thrombectomy,group C have transcatheter hepatic arterial chemoembolization after hepatectomy and thrombectomy. Results The 1-,2- and3-year overall survival rates were 31.8%,12.7% and 6.4% for group A,44.7%,23.2% and 11.6% for group B and49.0%,27.2% and 11.7% for group C,respectively. The overall survivals were significantly better in group B and group C than group A（P=0.049,P=0.033 respectively）. There was no statistical significant difference in group B and group C（P=0.751）. Conclusion Surgical intervention with postoperative transcatheter hepatic arterial chemoembolization or portal vein infusion chemotherapy is more effective than surgical intervention alone in treatment for large primary liver cancer with PVTT involving the main or first-order branches. However,it still needs to be carefully chosen if PVTT extends to the main trunk.