Surgical Contribution to Recurrence-Free Survival in Patients with Macrovascular-Invasion-Negative Hepatocellular Carcinoma
Surgical Contribution to Recurrence-Free Survival in Patients with Macrovascular-Invasion-Negative Hepatocellular Carcinoma
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DOI：
10.1016/j.jamcollsurg.2008.10.031
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发表时间：
2009-03-01
影响因子：
5.2
通讯作者：
Arii, Shigeki
中科院分区：
文献类型：
--
作者：
Tanaka, Shinji;Mogushi, Kaoru;Arii, Shigeki
背景技术背景：即使在根治性肝切除术后，宏观血管浸润（MVI）也是肝细胞癌（HCC）复发的众所周知的指标，但MVI阴性HCC复发的临床病理和分子特征仍不清楚。研究设计：207例确诊为原发性MVI阴性的连续患者在根治性切除术后进行回顾性评估，特别强调解剖学系统化肝切除术的重要性。我们还使用微阵列技术分析了HCC组织中每个肿瘤的全基因组基因表达谱。HCC复发的单变量分析显示多发性肿瘤（p < 0.001），中度至低分化（p = 0.044）、Child-Pugh B/C（p = 0.047）、α-铁蛋白升高（p = 0.007）和非解剖性肝切除术（p = 0.010）为风险因素。根据考克斯风险多变量分析，多肿瘤（p = 0.002），甲胎蛋白升高（p < 0.001），非解剖性肝切除（p = 0.002）被确定为复发的独立因素。肝癌解剖性切除术后复发病例中，局部复发率明显低于非解剖性切除术后（p < 0.001）。使用cDNA微阵列的网络表达分析揭示了上皮-间充质转化的不同信号通路与解剖系统化肝切除术后的复发相关。结论：解剖系统化肝切除术可能有助于无MVI的肝癌患者的无复发生存。局部复发大多可以通过解剖性肝切除来避免，尽管特定的上皮-间质转化信号可能调节HCC的生物侵袭性。（美国科尔外科杂志2009;208：368-374。(C)2009年美国外科医生学会）
BACKGROUND: Macroscopic vascular invasion (MVI) is a well-known indicator of recurrence of hepatocellular carcinoma (HCC) even after curative hepatectomy, but the clinicopathologic and molecular features of the recurrence remain unclear in MVI-negative HCC.STUDY DESIGN: Two hundred seven consecutive patients with confirmed primary MVI-negative HCC were retrospectively assessed after curative resection, with special emphasis on the importance of anatomically systematized hepatectomy. HCC tissues were also analyzed for genome-wide gene expression profile of each tumor using a microarray technique.RESULTS: Univariant analysis of HCC recurrence revealed multiple tumors (p < 0.001), moderate to poor differentiation (p = 0.044), Child-Pugh B/C (p = 0.047), alpha-feroprotein elevation (p = 0.007), and nonanatomic hepatectomy (p = 0.010) as risk factors. According to Cox hazard multivariant analysis, multiple tumors (p = 0.002), alpha-fetoprotein elevation (p < 0.001), and nonanatomic hepatectomy (p = 0.002) were identified as independent factors of the recurrence. In the recurrent cases after anatomic hepatectomy for HCC, local recurrence was significantly infrequent compared with those after nonanatomic hepatectomy (p < 0.001). Network expression analysis using cDNA microarray revealed distinct signaling pathways of epithelial-mesenchymal transitions are associated with recurrence after anatomically systematized hepatectomy.CONCLUSIONS: Anatomically systematized hepatectomy might contribute to recurrence-free survival of HCC patients of HCC without MVI. Local recurrence could be mostly averted by anatomic hepatectomy, although specific epithelial-mesenchymal transitions signaling might regulate the biologic aggressiveness of HCC. (J Am Coll Surg 2009;208:368-374. (C) 2009 by the American College of Surgeons)