Association of tumor morphology with long-term prognosis after liver resection for patients with a solitary huge hepatocellular carcinoma-a multicenter propensity score matching analysis.
Association of tumor morphology with long-term prognosis after liver resection for patients with a solitary huge hepatocellular carcinoma-a multicenter propensity score matching analysis.
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DOI：
10.21037/hbsn-21-423
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发表时间：
2023-06-01
影响因子：
8
通讯作者：
Yang, Tian
中科院分区：
文献类型：
--
作者：
Xu, Xin-Fei;Wu, Han;Li, Ju-Dong;Yao, Lan-Qing;Huang, Bin;Diao, Yong-Kang;Chen, Ting-Hao;Gu, Wei-Min;Chen, Zhong;Li, Jie;Zhang, Yao-Ming;Wang, Hong;Liang, Ying-Jian;Zhou, Ya-Hao;Li, Chao;Wang, Ming-Da;Zhang, Cheng-Wu;Pawlik, Timothy M.;Lau, Wan Yee;Shen, Feng;Yang, Tian
无大血管浸润和远处转移的孤立性肝细胞癌（HCC），无论肿瘤大小如何，目前被最新的巴塞罗那临床肝癌（BCLC）分期系统归类为早期疾病。虽然首选的治疗方法是手术切除，但对于≥10 cm的孤立性巨大HCC，肿瘤形态与肝切除术后长期生存结局的相关性尚未确定。从一个多中心数据库中确定了因孤立性巨大HCC而接受根治性肝切除术的患者。术前影像学检查结果用于将边缘光滑的球形或椭圆形病变定义为球囊形HCC（BS-HCC）;形状不规则的病变或边缘不光滑的任何形状的病变定义为非球囊形HCC（NBS-HCC）。使用倾向评分匹配（PSM）将BS-HCC和NBS-HCC患者的两组患者以1：1的比例匹配。评估临床病理特征、长期总生存期（OS）和无复发生存期（RFS）。在孤立性巨大HCC患者中，74对BS-HCC和NBS-HCC患者匹配。BS-HCC组的肿瘤病理特征包括微血管浸润、卫星结节和肿瘤包裹不完全的比例低于NBS-HCC组。在中位随访50.7个月时，PSM后所有孤立性巨大HCC患者的中位OS和RFS分别为27.8和10.1个月。BS-HCC组的中位OS和RFS优于NBS-HCC组（31.9 vs. 21.0个月，P=0.01; 19.7 vs. 6.4个月，P=0.015）。多变量分析确定BS-HCC与更好的OS（HR =0.592，P=0.009）和RFS（HR =0.633，P=0.013）独立相关。对于单个巨大肝癌，术前肿瘤形态学影像学检查与切除术后预后相关。特别是，与大NBS-HCC患者相比，BS-HCC患者在肝切除术后的长期生存率更高。
A solitary hepatocellular carcinoma (HCC) without macrovascular invasion and distant metastasis, regardless of tumor size, is currently classified as early-stage disease by the latest Barcelona Clinic Liver Cancer (BCLC) staging system. While the preferred treatment is surgical resection, the association of tumor morphology with long-term survival outcomes after liver resection for a solitary huge HCC of ≥10 cm has not been defined. Patients who underwent curative liver resection for a solitary huge HCC were identified from a multicenter database. Preoperative imaging findings were used to define spherical- or ellipsoidal-shaped lesions with smooth edges as balloon-shaped HCCs (BS-HCCs); out-of-shape lesions or lesions of any shape with matt edges were defined as non-balloon-shaped HCCs (NBS-HCCs). The two groups of patients with BS-HCCs and NBS-HCCs were matched in a 1:1 ratio using propensity score matching (PSM). Clinicopathologic characteristics, long-term overall survival (OS) and recurrence-free survival (RFS) were assessed. Among patients with a solitary huge HCC, 74 pairs of patients with BS-HCC and NBS-HCC were matched. Tumor pathological features including proportions of microvascular invasion, satellite nodules, and incomplete tumor encapsulation in the BS-HCC group were lower than the NBS-HCC group. At a median follow-up of 50.7 months, median OS and RFS of all patients with a solitary huge HCC after PSM were 27.8 and 10.1 months, respectively. The BS-HCC group had better median OS and RFS than the NBS-HCC group (31.9 vs. 21.0 months, P=0.01; and 19.7 vs. 6.4 months, P=0.015). Multivariate analyses identified BS-HCC as independently associated with better OS (HR =0.592, P=0.009) and RFS (HR =0.633, P=0.013). For a solitary huge HCC, preoperative imaging on tumor morphology was associated with prognosis following resection. In particular, patients with BS-HCCs had better long-term survival following liver resection versus patients with large NBS-HCCs.
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作者：
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