A Comparison of the Surgical Outcomes Among Patients With HBV-positive, HCV-positive, and Non-B Non-C Hepatocellular Carcinoma A Nationwide Study of 11,950 Patients
A Comparison of the Surgical Outcomes Among Patients With HBV-positive, HCV-positive, and Non-B Non-C Hepatocellular Carcinoma A Nationwide Study of 11,950 Patients
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DOI：
10.1097/sla.0000000000000821
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发表时间：
2015-03-01
影响因子：
9
通讯作者：
Kokudo, Norihiro
中科院分区：
文献类型：
--
作者：
Utsunomiya, Tohru;Shimada, Mitsuo;Kokudo, Norihiro
目的：比较B型肝炎病毒（HBV）阳性、丙型肝炎病毒（HCV）阳性、以及B型肝炎表面抗原和丙型肝炎抗体阴性（即所谓的“NBNC”-肝细胞癌（HCC））患者肝切除术后的预后因素和结局。共有11，950例接受根治性肝切除术的HBV-HCC（n = 2194）、HCV-HCC（n = 7018）或NBNC-HCC（n = 2738）患者入组本研究。比较各组的临床病理特征。结果：HCV-HCC组肝功能明显差于HBV-HCC组和NBNC-HCC组。NBNC-HCC组比HCV-HCC组有更显著的晚期HCC。在HBV-HCC、HCV-HCC和NBNC-HCC组中，肝切除术后的5年总生存率分别为65%、59%和68%。这3组的5年无复发生存率（RFS）分别为41%、31%和47%。根据TNM分期对RFS率进行分层显示，NBNC-HCC组在II期、III期和IVA期的预后明显好于HBV-HCC组，在I期和II期的预后明显好于HCV-HCC组。多变量分析显示，NBNC-HCC组的RFS率显着更好：结论：这项全国性调查的结果表明，NBNC-HCC患者的肝癌复发的风险显着低于那些与HBV-肝癌和HCV-肝癌。
Objective: To compare the prognostic factors and outcomes after hepatic resection among patients with hepatitis B virus (HBV)-positive, hepatitis C virus (HCV)-positive, and negative for hepatitis B surface antigen and hepatitis Cantibody, so-called "NBNC"-hepatocellular carcinoma (HCC) using the data from a nationwide survey.Background: The incidence of NBNC-HCC is rapidly increasing in Japan.Methods: A total of 11,950 patients with HBV-HCC (n = 2194), HCV-HCC (n = 7018), or NBNC-HCC (n = 2738) who underwent a curative hepatic resection were enrolled in this study. The clinicopathological features were compared among the groups. The significant prognostic variables determined by univariate analysis were subjected to a multivariate analysis using a Cox proportional hazard regression model.Results: Liver function in the HCV-HCC group was significantly worse than that in the HBV-HCC and NBNC-HCC groups. The NBNC-HCC group had significantly more advanced HCC than the HCV-HCC group. The 5-year overall survival rates after hepatectomy in the HBV-HCC, HCV-HCC, and NBNC-HCC groups were 65%, 59%, and 68%, respectively. The 5-year recurrence-free survival (RFS) rates in these 3 groups were 41%, 31%, and 47%, respectively. Stratifying the RFS rates according to the TNM stage showed that the NBNC-HCC group had a significantly better prognosis than the HBV-HCC group in stages II, III, and IVA, and a significantly better prognosis than the HCV-HCC group in stages I and II. Multivariate analysis revealed a significantly better RFS rate in the NBNC-HCC group.Conclusions: The findings of this nationwide survey indicated that patients with NBNC-HCC had a significantly lower risk of HCC recurrence than those with HBV-HCC and HCV-HCC.