Schwarz Roderich E, Smith David D
Division of Surgical Oncology, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
Am J Surg. 2008 Jun;195(6):829-36. doi: 10.1016/j.amjsurg.2007.10.010. Epub 2008 Apr 23.
Hepatocellular cancer (HCC) frequently presents with limitations to resection. We investigated survival outcomes after various local HCC therapies in US patients.
Relationships between local HCC therapy modality and overall survival (OS) were analyzed from the Surveillance, Epidemiology and End Results (SEER) 1973-2003 database. Of 46,065 patients with primary hepatobiliary malignancy, 5,317 individuals with HCC had sufficient surgical data. The median age was 65 (range 0-105), and 73% of patients were male. The median tumor size was 6 cm (.2-30). There were single lesions (52%), multiple lesions (28%), and extrahepatic disease (20%). Mortality at 30 days was 8.4% (resection), 3.3% (transplantation), 3.2% (ablation), or 31% (no local therapy, P <.0001). Actuarial 5-year survival was 67% after transplantation, 35% after resection, 20% after ablation, and 3% for no or incomplete local therapy (P <.0001). Multivariate prognosticators were surgical modality, disease extent, grade (all at P <.0001), tumor size (P = .01), vascular invasion (P = .02), and age (P = .045). Compared to resection, risk ratios were .56 (transplantation) and 1.53 (ablation).
Long-term HCC survival can be observed after all 3 treatment approaches but is best after transplantation and resection, although likely biased through confounding patient selection variables. Preferred HCC treatment should be individualized based on morbidity and long-term OS prospects.
肝细胞癌（HCC）常常存在手术切除受限的情况。我们调查了美国患者接受各种局部肝癌治疗后的生存结果。
从监测、流行病学和最终结果（SEER）1973 - 2003数据库分析局部肝癌治疗方式与总生存期（OS）之间的关系。在46065例原发性肝胆恶性肿瘤患者中，5317例肝癌患者有足够的手术数据。中位年龄为65岁（范围0 - 105岁），73%的患者为男性。中位肿瘤大小为6厘米（0.2 - 30厘米）。有单发肿瘤（52%）、多发肿瘤（28%）和肝外疾病（20%）。30天死亡率为8.4%（手术切除）、3.3%（移植）、3.2%（消融）或31%（未进行局部治疗，P < 0.0001）。移植后5年精算生存率为67%，手术切除后为35%，消融后为20%，未进行或局部治疗不完全者为3%（P < 0.0001）。多因素预后因素包括手术方式、疾病范围、分级（均P < 0.0001）、肿瘤大小（P = 0.01）、血管侵犯（P = 0.02）和年龄（P = 0.045）。与手术切除相比，风险比分别为0.56（移植）和1.53（消融）。
所有三种治疗方法后均可观察到肝癌的长期生存，但移植和手术切除后的生存情况最佳，不过可能因患者选择变量的混杂而存在偏差。首选的肝癌治疗应根据发病率和长期总生存期前景进行个体化选择。
