肝细胞癌（hepatocellular carcinoma，HCC）且存在门静脉血栓（Portal vein tumor thrombosis，PVTT）的患者常预后不佳，尽管进行了多种努力以提高预后，但目前对此类患者尚无合适的治疗。美国肝病研究学会（AASLD）第63届年会上，来自意大利的一项研究显示，针对PVTT的治疗可以提高晚期HCC患者生存率。
研究者纳入60名晚期HCC合并PVTT患者（2008年5月至2012年4月就诊的患者，51名男性，9名女性，平均年龄66±5.6岁）进行回顾性研究，评估其流行病学数据、肿瘤和潜在肝疾病特征、总生存率和治疗相关生存率。并评估与PVTT进展、恶化相关的变量，以及瘤栓治疗对晚期HCC患者生存率的影响。纳入病例包括存在主门静脉瘤栓、门静脉分支瘤栓患者，依据影像学检查中的典型血流动力学模型确诊。从肿瘤和PVTT诊断均确立时开始计算总生存率。此外，还应用生存分析评估了实施治疗对预后的可能影响。
结果发现，33/60（55%）名患者接受过系统抗血管生成治疗；6/60（10%）患者接受过针对瘤栓的外放射治疗；21/60（35%）名患者未接受任何治疗。所有患者均接受过针对HCC病灶的最佳治疗。多变量分析显示确诊HCC后出现瘤栓的时间与病毒病因学及确诊HCC时的BCLC分期显著相关，而瘤栓扩散与门脉高压显著相关。在观察期末（47个月），每组的生存率分别为18%、50%、23%。从确诊HCC时起计算的总生存期为753±88天，与确诊时年龄小、BCLC分级A级、针对HCC病灶进行治疗显著相关，而与针对PVTT的治疗无关。从确诊PVTT时起计算的总生存期为397±77天。每组平均生存期分别为408±86天（抗血管生成治疗组），855±273天（外放射治疗组），140±29天（未接受治疗组）（p<0.001），未考虑年龄和潜在肝病的严重程度等因素。
该研究得出结论：如果不考虑年龄因素，针对PVTT的治疗可以提高晚期HCC患者生存率。对这类患者，外放射治疗似乎是最好的治疗选择。然而，PVTT治疗不能影响从确诊HCC时起计算的总生存期。而且，需要进一步深入进行患者特征、肿瘤特征对治疗效果是否存在影响的评估性研究。
研究论文
RESULTS:From May 2008 to April 2012 60 patients(51 male, 9 female; mean age 66±5.6) were recruited for retrospective evaluation. 33/60 (55%) patients underwent systemic antiangiogenetic therapy; 6/60 (10%) were referred to external beam radiation therapy on thrombus; 21/60 (35%) not receive any active therapy. All patients received the best treatment on HCC concomitant nodules. A multivariate analysis showed that time between the onset of thrombosis and the diagnosis of HCC is significantly correlated to viral aetiology and BCLC stage at the diagnosis of HCC, while thrombosis extension is significantly correlated to the presence of portal hypertension. At the end of observation (47 months), survival for each group was 18%, 50% and 23%, respectively. The overall survival from the diagnosis of HCC was 753±88 days and it is significantly correlated to younger age at diagnosis, BCLC A and treatment performed on HCC nodule, but not according to PVTT treatment. The overall survival from the diagnosis of PVTT was 397±77 days.According to each group, mean survival was 408±86 days for the first group(antiangiogenetic therapy),855±273 days for the second group (radiation therapy),140±29 days for patients who had not received any therapy(p<0.001), regardless of age or severity of underlying liver disease.
CONCLUSION:PVTT treatment seems to improve survival of patients with advanced HCC, regardless of age. In particular radiation therapy seems to be the best treatment option for this kind of patients. Nevertheless PVTT treatment seems not to affect overall survival from time of diagnosis of HCC.Further studies are necessary to evaluate the impact of patients and tumor characteristics on treatment efficacy.
Treatment of portal vein tumor thrombosis (pvtt) can impact survival of patients with advanced HCC?
INTRODUCTION:HCC with PVTT is often associated with poor prognosis. Many efforts have been made to improve prognosis in this setting, but nowadays there is not a treatment of choice for HCC related PVTT.
AIMS&METHODS:We retrospectively assessed epidemiologic data, tumor and underlying liver disease features, overall survival and treatment-related survival of 60 patients affected by advanced HCC complicated by PVTT. Moreover we evaluated variables associated to PVTT development and severity, and the impact of tumor thrombosis treatment on survival of patients with advanced HCC. We included both
main portal vein and segmentary branches thrombosis. Diagnosis was made according to typical dynamic contrast pattern on radiological main techniques. We calculated overall survival by the time of both PVTT diagnosis and tumor onset. In addition we evaluated a possible role of performed treatment on conditioning prognosis. A Kaplan-Meier analysis was performed.
RESULTS:From May 2008 to April 2012 60 patients(51 male, 9 female; mean age 66±5.6) were recruited for retrospective evaluation. 33/60 (55%) patients underwent systemic antiangiogenetic therapy; 6/60 (10%) were referred to external beam radiation therapy on thrombus; 21/60 (35%) not receive any active therapy. All patients received the best treatment on HCC concomitant nodules. A multivariate analysis showed that time between the onset of thrombosis and the diagnosis of HCC is significantly correlated to viral aetiology and BCLC stage at the diagnosis of HCC, while thrombosis extension is significantly correlated to the presence of portal hypertension. At the end of observation (47 months), survival for each group was 18%, 50% and 23%, respectively. The overall survival from the diagnosis of HCC was 753±88 days and it is significantly correlated to younger age at diagnosis, BCLC A and treatment performed on HCC nodule, but not according to PVTT treatment. The overall survival from the diagnosis of PVTT was 397±77 days.According to each group, mean survival was 408±86 days for the first group(antiangiogenetic therapy),855±273 days for the second group (radiation therapy),140±29 days for patients who had not received any therapy(p<0.001), regardless of age or severity of underlying liver disease.
CONCLUSION:PVTT treatment seems to improve survival of patients with advanced HCC, regardless of age. In particular radiation therapy seems to be the best treatment option for this kind of patients. Nevertheless PVTT treatment seems not to affect overall survival from time of diagnosis of HCC.Further studies are necessary to evaluate the impact of patients and tumor characteristics on treatment efficacy.
