Hepatectomy for hepatocellular carcinoma with major portal or hepatic vein invasion: Results of a multicenter study

医学 肝细胞癌 肝切除术 围手术期 胃肠病学 内科学 外科 单变量分析 静脉 存活率 纤维化 生存分析 多元分析 切除术
作者
Timothy M. Pawlik,Ronnie T. P. Poon,Eddie K. Abdalla,Iwao Ikai,David M. Nagorney,Jacques Belghiti,Réza Kianmanesh,Irene Oi Lin Ng,Steven A. Curley,Yoshio Yamaoka,Gregory Y. Lauwers,Jean Nicolas Vauthey
出处
期刊:Surgery [Elsevier]
卷期号:137 (4): 403-410 被引量:216
标识
DOI:10.1016/j.surg.2004.12.012
摘要

The role of hepatic resection in patients with hepatocellular carcinoma (HCC) and invasion of a main portal or hepatic vein branch is controversial. We evaluated the efficacy of hepatic resection and the factors affecting survival after resection in such patients.The records of 102 patients who underwent resection for HCC with major vascular invasion between 1984 and 1999 were reviewed. Prognostic factors were evaluated by univariate and multivariate analysis.The study included 87 men and 15 women. The median age was 59 years. The perioperative mortality rate was 5.9%. Median survival was 11 months (median follow-up, 93 months). The 1-, 3-, and 5-year survival rates were 45%, 17%, and 10%; the longest-living survivor was still alive at 14.8 years. Absence of moderate to severe fibrosis and absence of high nuclear grade were associated with a better 5-year survival rate (23% vs 5%; P = .001 and 21% vs 9%; P = .04, respectively). On multivariate analysis, moderate to severe fibrosis remained a significant predictor of both short-term (< or = 6 months) and long-term (>6 months) survival ( P < .03 and P < .01, respectively).Hepatic resection for HCC with major vascular invasion is associated with median survival exceeding historical survival in patients not treated surgically. Patients with HCC and major vascular invasion who derive long-term benefit from resection have no or minimal underlying fibrosis.
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