Background: Liver transplantation (LT) is a promising treatment option for patients with hepatocellular carcinoma (HCC) comorbid with cirrhosis. However, HCC with portal vein tumor thrombosis (PVTT) remains an absolute contraindication for LT. This study aimed to analyze the outcomes of LT in patients with HCC plus portal vein thrombosis and further evaluate the impact of PVTT on the long-term outcomes of patients. Methods: Among the 501 patients who underwent LT for HCC between January 2000 and March 2023, 29 (5.8%) patients with HCC who had portal vein thrombosis were further analyzed. Of these 29 patients with portal vein thrombosis, 12 (41.4%) were preoperatively diagnosed with PVTT and underwent LT after receiving downstaging therapy. The remaining 17 (58.6%) patients were PVTT-free prior to LT. Results: Overall, the recurrence-free survival rates at 1, 3, and 5 years were 96.3%, 74.2%, and 74.2%, respectively, while the 1-, 3-, and 5-year overall survival rates were 82.4%, 74.2%, and 70.1%, respectively. However, patients with viable PVTT had significantly worse outcomes than those without viable PVTT (p= 0.030). The 5-year recurrence-free and overall survival rates for patients with viable PVTT were 57.5% and 57.0%, respectively. Conclusions: LT may still be a promising option for patients with HCC and PVTT after appropriate downstaging. However, caution should be adopted, as remnant viable PVTT might lead to unsatisfactory outcomes after transplantation.
背景：肝移植是治疗合并肝硬化的肝细胞癌患者的一种有效治疗选择。然而，合并门静脉癌栓的肝细胞癌目前仍是肝移植的绝对禁忌症。本研究旨在分析肝细胞癌合并门静脉血栓患者接受肝移植的预后，并进一步评估门静脉癌栓对患者长期预后的影响。方法：在2000年1月至2023年3月期间因肝细胞癌接受肝移植的501例患者中，对29例（5.8%）合并门静脉血栓的肝细胞癌患者进行深入分析。在这29例门静脉血栓患者中，12例（41.4%）术前确诊为门静脉癌栓，并在接受降期治疗后接受了肝移植；其余17例（58.6%）患者在移植前未发现门静脉癌栓。结果：总体而言，患者的1年、3年和5年无复发生存率分别为96.3%、74.2%和74.2%，而1年、3年和5年总生存率分别为82.4%、74.2%和70.1%。然而，存在活性门静脉癌栓的患者预后显著差于无活性癌栓患者（p=0.030）。活性门静脉癌栓患者的5年无复发生存率和总生存率分别为57.5%和57.0%。结论：经过适当的降期治疗后，肝移植对于合并门静脉癌栓的肝细胞癌患者仍可能是一种有前景的治疗选择。但需谨慎对待，因为残留的活性门静脉癌栓可能导致移植后预后不佳。
肿瘤(癌症)患者之家