Cillo Umberto, Vitale Alessandro, Brolese Alberto, Zanus Giacomo, Neri Daniele, Valmasoni Michele, Bonsignore Pasquale, Grigoletto Francesco, Burra Patrizia, Farinati Fabio, D'Amico Davide Francesco
Unità di chirurgia epatobiliare e trapianto di fegato, Dipartimento assistenziale di chirurgia generale e trapianti d'organo, University of Padua, School of Medicine, Padova, Italy.
J Surg Oncol. 2007 Mar 1;95(3):213-20. doi: 10.1002/jso.20641.
Partial hepatectomy (PH) and liver transplantation (LT) compete as first-line treatment for hepatocellular carcinoma (HCC). A prospectively collected database was retrospectively reviewed to establish when PH can compete with LT.
Between 1991 and 2002, PH was performed in 131 cases of HCC (Child-Pugh A-B, technically resectable tumor without metastases). To ascertain patient survival after PH, we compared this series with a group of 40 HCC patients (G1-G2 HCC with no gross vascular invasion or metastasis) enlisted for liver transplantation during the same period.
The 1-, 3-, and 5-year intention-to-treat survival rates were 75%, 52%, and 31% for resection and 89%, 71%, and 63% for transplantation. Two tumor-related variables (gross vascular invasion and histological grade) and three liver function parameters (Child-Pugh score, bilirubin, Okuda stage) proved to be independent predictors of survival after resection, whereas nodule size and number, and Milan criteria did not. The 5-year survival of the best candidates for resection (favorable tumor biology with very well preserved liver function, n = 52) was 58%. On a descriptive basis alone, this result did not differ significantly from the outcome in LT patients. PH patients with a poorly differentiated tumor and/or gross vascular invasion (n = 28) had the worst outcome, irrespective of their liver function parameters.
For technically resectable tumors without aggressive features (G3 or macroscopic vascular invasion), PH can only compete with LT, in terms of long-term survival, when patients with a well-preserved liver function are selected.
肝部分切除术（PH）和肝移植（LT）是肝细胞癌（HCC）一线治疗的可选择方法。回顾性分析一个前瞻性收集的数据库，以确定PH何时可与LT相媲美。
1991年至2002年间，对131例HCC患者（Child-Pugh A - B级，技术上可切除且无转移的肿瘤）实施了PH。为确定PH术后患者的生存率，我们将该组患者与同期入选肝移植的40例HCC患者（G1 - G2级HCC，无明显血管侵犯或转移）进行了比较。
切除组1年、3年和5年意向性治疗生存率分别为75%、52%和31%，移植组分别为89%、71%和63%。两个肿瘤相关变量（明显血管侵犯和组织学分级）和三个肝功能参数（Child-Pugh评分、胆红素、奥田分期）被证明是切除术后生存的独立预测因素，而结节大小和数量以及米兰标准则不是。切除的最佳候选者（肿瘤生物学特性良好且肝功能保存良好，n = 52）的5年生存率为58%。仅从描述性角度来看，这一结果与LT患者的结果无显著差异。肿瘤分化差和/或有明显血管侵犯的PH患者（n = 28）预后最差，无论其肝功能参数如何。
对于技术上可切除且无侵袭性特征（G3或肉眼可见血管侵犯）的肿瘤，仅在选择肝功能保存良好的患者时，PH在长期生存方面才能与LT相媲美。
