Liver resection is justified for multinodular hepatocellular carcinoma in selected patients with cirrhosis: A multicenter analysis of 1,066 patients
Liver resection is justified for multinodular hepatocellular carcinoma in selected patients with cirrhosis: A multicenter analysis of 1,066 patients
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对于选定的肝硬化患者的多结节性肝细胞癌，肝切除术是合理的：对 1,066 名患者进行的多中心分析
DOI：
10.1016/j.ejso.2018.12.016
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发表时间：
2019-05-01
期刊：
影响因子：
3.8
通讯作者：
Yang, Tian
中科院分区：
文献类型：
--
作者：
Li, Zhen-Li;Yu, Jiong-Jie;Yang, Tian
背景资料：肝切除术对多结节（≥ 3个结节）肝细胞癌（HCC）的作用尚不清楚，特别是在有严重基础肝病的患者中。我们试图评估肝硬化和多结节性肝癌患者接受肝切除术的手术结果：使用多中心数据库，肝硬化患者接受根治性切除术的HCC的结果进行了检查分层根据存在或不存在多结节性疾病。结果：在1066例原发性肝癌患者中，906例（85.0%）为单结节或双结节型（非多结节组），160例（15.0%）为多结节型（多结节组）。非多结节患者与多结节患者的术后30天死亡率和发病率无差异（分别为1.8% vs. 1.9%，P = 0.923和36.0% vs. 39.4%，P = 0.411）。相比之下，多结节患者的5年OS和RFS比非多结节患者差（34.6% vs. 58.2%，24.7% vs. 44.5%，均P < 0.001）。多变量分析显示，肿瘤数量>= 5，肿瘤总直径>= 8 cm和微血管浸润是肝硬化患者切除多结节性肝癌后OS和RFS降低的独立危险因素。结论：肝切除术可以安全地用于肝硬化背景下的多结节性肝癌，5年生存率为34.6%。肿瘤数量≥ 5个、肿瘤总直径≥ 8 cm和微血管浸润与多结节性HCC患者切除术后OS和RFS降低独立相关。(C)2018 Elsevier Ltd，BASO类似于癌症外科协会和欧洲外科肿瘤学会。All rights reserved.
Background: The role of liver resection for multinodular (>= 3 nodules) hepatocellular carcinoma (HCC) remains unclear, especially among patients with severe underlying liver disease. We sought to evaluate surgical outcomes among patients with cirrhosis and multinodular HCC undergoing liver resection.Methods: Using a multicenter database, outcomes among cirrhotic patients who underwent curative intent resection of HCC were examined stratified according to the presence or absence of multi nodular disease. Perioperative mortality and morbidity, as well as overall survival (OS) and recurrence free survival (RFS) were compared between the two groups.Results: Among 1066 cirrhotic patients, 906 (85.0%) had single- or double-nodular HCC (the non-multinodular group), while 160 (15.0%) had multinodular HCC (the multinodular group). There were no differences in postoperative 30-day mortality and morbidity among non-multinodular versus multinodular patients (1.8% vs. 1.9%, P = 0.923, and 36.0% vs. 39.4%, P = 0.411, respectively). In contrast, 5-year OS and RFS of multinodular patients were worse compared with non-multinodular patients (34.6% vs. 58.2%, and 24.7% vs. 44.5%, both P < 0.001). On multivariable analyses, tumor numbers >= 5, total tumor diameter >= 8 cm and microvascular invasion were independent risk factors for decreased OS and RFS after resection of multinodular HCC in cirrhotic patients.Conclusions: Liver resection can be safely performed for multinodular HCC in the setting of cirrhosis with an overall 5-year survival of 34.6%. Tumor number >= 5, total tumor diameter >= 8 cm and microvascular invasion were independently associated with decreased OS and RFS after resection in cirrhotic patients with multinodular HCC. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.