Influencing factors of liver regeneration after portal vein embolization in patients with type III and IV hilar cholangiocarcinoma
LIU Yipiao1, 2, GUO Zhiying2, LIU Jiaxing2, FAN Haining1, LU Qian2
1.Department of Hepatobiliary Surgery, Qinghai University, Xining 810016, China; 2.Department of Hepatobiliary and Pancreatic Center, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
LIU Yipiao,GUO Zhiying,LIU Jiaxing, et al. Influencing factors of liver regeneration after portal vein embolization in patients with type III and IV hilar cholangiocarcinoma[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2022, 52(9): 729-735.
Abstract：Objective: To investigate the influencing factors of liver regeneration after portal vein embolization for Bismuth-Corlett type III and type IV hilar cholangiocarcinoma. Methods: Clinical data of 72 patients with Bismuth-Corlett type III and Type IV hilar cholangiocarcinoma treated by PVE were collected from June 2016 to December 2021 in Hepatobiliary and Pancreatic Center of Affiliated Tsinghua Chang-geng Hospital of Tsinghua University. The patients were divided into the high regeneration group (38 cases) and the low regeneration group (34 cases) according to the median future residual liver regeneration rate at the third week after PVE surgery. The liver regeneration, influencing factors and survival time of the two groups were retrospectively analyzed. Results: The FLR before PVE was (447.97±99.93)mL, and the median FLRR was 33.83%, less than the critical value of 40%. Three weeks after PVE, FLR increased to (582.80±106.60)mL and the median FLRR was 44.32%. The FLR was (134.83±48.73)mL, with a median FLR regeneration rate of 27.6%. Bismuth-Corlett type before PVE (P=0.027), CA19-9 level (P=0.037), regional lymph node metastasis (P=0.019) and liver fibrosis (P=0.014) were significantly different between the high and low regeneration groups. There was no significant difference in other indicators between the two groups. Logistic multivariate regression analysis showed that liver fibrosis (P=0.034) was a major risk factor for liver regeneration after PVE. There were 72 patients with hilar cholangiocarcinoma, with an overall median survival time of 12.2 months, with 95%CI=7.934-16.406. The median survival time of the high regeneration group and the low regeneration group was 18.0 months and of 5.8 months respectively, showing statistical difference (P=0.041). Conclusion: PVE can promote liver regeneration in patients with Bismuth-Corlett type III and type IV hilar cholangiocarcinoma. The median survival time of high regeneration group was longer than that of low regeneration group. The influencing factors of liver regeneration include cholangiocarcinoma type, lymph node metastasis, CA19-9 and fibrosis. Liver fibrosis is a major risk factor affecting liver regeneration.
