肝切除术对比免疫治疗在门静脉癌栓的肝细胞癌中的临床疗效

The Clinical Efficacy of Hepatectomy Compared to Immunotherapy in Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

摘要: 目的：免疫治疗被认为是治疗肉眼可见门静脉癌栓(PVTT)的肝细胞癌(HCC)患者的一线药物。本研究进行回顾性分析，以评估肉眼可见PVTT患者的最佳一线治疗方案。方法：纳入接受肝切除术和接受免疫治疗的PVTT的HCC患者。比较每种PVTT类别的两种治疗方式之间的治疗结果。结果：接受肝切除术的I型、II型和III型PVTT患者的中位生存期(MST)分别为43.1、32和17.2个月；接受免疫治疗的I型、II型和III型PVTT患者的MST分别为18.3、12.7和11.0个月，I型和II型的PVTT患者差异具有显著统计学意义(P < 0.001)。在Cox比例风险模型中，单因素分析显示，最大直径、PVTT分型、治疗方式、病灶数目与总生存期相关，多因素分析显示，最大直径、PVTT分型、治疗方式与总生存期相关。结论：肝切除术可延长HCC伴有肉眼可见PVTT患者的生存期。

Abstract: Objective: Immunotherapy is considered as the first-line drug for hepatocellular carcinoma (HCC) patients with visible portal vein tumor thrombus (PVTT). This study conducted a retrospective analysis to evaluate the best first-line treatment for patients with macroscopic PVTT. Methods: HCC patients with PVTT who received hepatectomy and immunotherapy were included to compare the treatment results between the two treatment methods for each PVTT category. Results: The median survival time (MST) of patients with type I, type II and type III PVTT undergoing hepatectomy was 43.1, 32 and 17.2 months respectively. The MST of patients with type I, type II and type III PVTT who received immunotherapy was 18.3, 12.7 and 11.0 months, respectively. There was significant difference between type I and type II PVTT patients (P < 0.001). In Cox proportional hazard model, univariate analysis showed that the maximum diameter, PVTT classification, treatment method and the number of lesions were related to the overall survival, and multivariate analysis showed that the maximum diameter, PVTT classification and treatment method were related to the overall survival. Conclusion: Hepatectomy can prolong the survival time of HCC patients with macroscopic PVTT.