Comparison of Recurrence of Hepatocellular Carcinoma After Resection in Patients with Cirrhosis to Its Occurrence in a Surveilled Cirrhotic Population
Comparison of Recurrence of Hepatocellular Carcinoma After Resection in Patients with Cirrhosis to Its Occurrence in a Surveilled Cirrhotic Population
复制标题
DOI：
10.1245/s10434-008-0232-4
复制
发表时间：
2009-02-01
影响因子：
3.7
通讯作者：
Pinna, Antonio Daniele
中科院分区：
文献类型：
--
作者：
Cucchetti, Alessandro;Piscaglia, Fabio;Pinna, Antonio Daniele
与非肝硬化对照受试者相比，肝硬化是肝切除术后 2 年肝细胞癌 (HCC) 复发的唯一危险因素；然而，缺乏专门针对肝硬化患者的队列数据。本研究旨在评估肝硬化切除后早期（< 2 年）和晚期（> 2 年）复发的危险因素和年发生率，并将这些结果与参加 HCC 监测计划的肝硬化患者（HCC 发生）进行比较。回顾性收集 204 名因 HCC 切除的肝硬化患者和 150 名接受肝硬化监测的患者的数据，并使用倾向评分匹配进行比较，以克服非随机研究的偏差。早期复发的危险因素（发生率 = 21.8%/年）是血清甲胎蛋白 (AFP) 水平较高、肿瘤分化不良和存在微血管侵犯 (P < 0.05)。晚期复发（18.4%/年）和 HCC 发生（3.3%/年）的危险因素是男性、年龄较大和血清转氨酶水平较高；多原发肿瘤和较高的 AFP 分别是晚期复发和 HCC 发生的额外危险因素（P < 0.05）。倾向调整后，具有少于两个晚期复发危险因素的切除患者的 HCC 年发病率（6.2%/年）与具有千分之二危险因素的受监测患者相似（5.8%/年；P = 0.898）。肝硬化患者切除后早期和晚期肝癌复发具有不同的危险因素。切除后2年或以上的HCC年发病率可能与普通患者相似，因为涉及相同的危险因素；对这些特征的评估可能有助于调整临床管理。
The presence of cirrhosis is the only risk factor that is advocated for recurrence of hepatocellular carcinoma (HCC) 2 years after hepatic resection compared with noncirrhotic control subjects; however, data for cohorts of exclusively patients with cirrhosis are lacking. This study was designed to assess risk factors and annual incidence of early (< 2 years) and late (> 2 years) recurrence after resection of cirrhosis and to compare these findings with those of patients with cirrhosis enrolled in HCC surveillance programs (HCC occurrence). Data from 204 patients with cirrhosis resected for HCC and 150 surveilled for cirrhosis were retrospectively collected and compared using propensity score matching to overcome biases of nonrandomized study. Risk factors for early recurrence (incidence = 21.8%/year) were higher serum alpha-fetoprotein (AFP) levels, poorly differentiated tumor, and presence of microvascular invasion (P < 0.05). Risk factors for both late recurrence (18.4%/year) and HCC occurrence (3.3%/year) were male gender, older age, and higher serum transaminase levels; multiple primary tumors and higher AFP were additional risk factors for late recurrence and HCC occurrence respectively (P < 0.05). After propensity adjustment, resected patients with less than two risk factors for late recurrence showed an annual incidence of HCC (6.2%/year) similar to that of surveilled patients with a parts per thousand yen2 risk factors (5.8%/year; P = 0.898). Early and late recurrence of HCC for patients with cirrhosis after resection have distinct risk factors. Annual incidence of HCC 2 years or more after resection may be similar to that of general patients because the same risk factors are involved; assessment of these characteristics could be useful in tailoring clinical management.