Patients with advanced hepatocellular carcinoma(HCC) showing portal vein tumor thrombosis(PVTT) have an extremely poor prognosis. According to treatment guidelines, the only option for HCC patients with PVTT is sorafe...Patients with advanced hepatocellular carcinoma(HCC) showing portal vein tumor thrombosis(PVTT) have an extremely poor prognosis. According to treatment guidelines, the only option for HCC patients with PVTT is sorafenib chemotherapy. However, in Asia, various treatments have been attempted and possible prolongation of overall survival has been repeatedly reported. We herein report the first case of a patient with an initially unresectable advanced HCC with PVTT who underwent curative hepatectomy after sorafenib and transcatheter arterial chemoembolization(TACE) showing complete histological response. Two months after induction with sorafenib, a significant decrease in serum alpha-fetoprotein level was observed and computed tomography imaging showed a significant decrease in tumor size. Because of remaining PVTT, TACE and curative resection were performed. The combination of sorafenib and TACE may be an effective treatment for HCC patients with PVTT.展开更多
AIM To clarify the clinical factors associated with liver regeneration after major hepatectomy and the hypertrophic rate after portal vein embolization(PVE).METHODS A total of 63 patients who underwent major hepatecto...AIM To clarify the clinical factors associated with liver regeneration after major hepatectomy and the hypertrophic rate after portal vein embolization(PVE).METHODS A total of 63 patients who underwent major hepatectomy and 13 patients who underwent PVE in a tertiary care hospital between January 2012 and August 2015 were included in the analysis.We calculated the remnant liver volume following hepatectomy using contrast-enhanced computed tomography(CT) performed before and approximately 3-6 mo after hepatectomy.Furthermore,we calculated the liver volume using CT performed 2-4 wk after PVE.Preoperative patient characteristics and laboratory data were analyzed to identify factors affecting postoperative liver regeneration or hypertrophy rate following PVE.RESULTS The remnant liver volume/total liver volume ratio negatively correlated with the liver regeneration rate after hepatectomy(ρ =-0.850,P < 0.001).The regeneration rate was significantly lower in patients with an indocyanine green retention rate at 15 min(ICG-R15) of ≥ 20% in the right hepatectomy group but not in the left hepatectomy group.The hypertrophic rate after PVE positively correlated with the regeneration rate after hepatectomy(ρ = 0.648,P = 0.017).In addition,the hypertrophic rate after PVE was significantly lower in patients with an ICG-R15 ≥ 20% and a serum total bilirubin ≥ 1.5 mg/d L.CONCLUSION The regeneration rate after major hepatectomy correlated with hypertrophic rate after PVE.Both of them were attenuated in the presence of impaired liver function.展开更多
文摘Patients with advanced hepatocellular carcinoma(HCC) showing portal vein tumor thrombosis(PVTT) have an extremely poor prognosis. According to treatment guidelines, the only option for HCC patients with PVTT is sorafenib chemotherapy. However, in Asia, various treatments have been attempted and possible prolongation of overall survival has been repeatedly reported. We herein report the first case of a patient with an initially unresectable advanced HCC with PVTT who underwent curative hepatectomy after sorafenib and transcatheter arterial chemoembolization(TACE) showing complete histological response. Two months after induction with sorafenib, a significant decrease in serum alpha-fetoprotein level was observed and computed tomography imaging showed a significant decrease in tumor size. Because of remaining PVTT, TACE and curative resection were performed. The combination of sorafenib and TACE may be an effective treatment for HCC patients with PVTT.
文摘AIM To clarify the clinical factors associated with liver regeneration after major hepatectomy and the hypertrophic rate after portal vein embolization(PVE).METHODS A total of 63 patients who underwent major hepatectomy and 13 patients who underwent PVE in a tertiary care hospital between January 2012 and August 2015 were included in the analysis.We calculated the remnant liver volume following hepatectomy using contrast-enhanced computed tomography(CT) performed before and approximately 3-6 mo after hepatectomy.Furthermore,we calculated the liver volume using CT performed 2-4 wk after PVE.Preoperative patient characteristics and laboratory data were analyzed to identify factors affecting postoperative liver regeneration or hypertrophy rate following PVE.RESULTS The remnant liver volume/total liver volume ratio negatively correlated with the liver regeneration rate after hepatectomy(ρ =-0.850,P < 0.001).The regeneration rate was significantly lower in patients with an indocyanine green retention rate at 15 min(ICG-R15) of ≥ 20% in the right hepatectomy group but not in the left hepatectomy group.The hypertrophic rate after PVE positively correlated with the regeneration rate after hepatectomy(ρ = 0.648,P = 0.017).In addition,the hypertrophic rate after PVE was significantly lower in patients with an ICG-R15 ≥ 20% and a serum total bilirubin ≥ 1.5 mg/d L.CONCLUSION The regeneration rate after major hepatectomy correlated with hypertrophic rate after PVE.Both of them were attenuated in the presence of impaired liver function.
