Ho Ming-Chih, Huang Guan-Tarn, Tsang Yuk-Ming, Lee Po-Huang, Chen Ding-Shinn, Sheu Jin-Chuan, Chen Chien-Hung
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Ann Surg Oncol. 2009 Apr;16(4):848-55. doi: 10.1245/s10434-008-0282-7. Epub 2009 Jan 22.
According to current guidelines of hepatocellular carcinoma (HCC) treatment, multiple HCCs are usually not suitable for surgical resection. However, surgical resection is still possible for patients with multiple HCCs. The role of hepatic resection vs transarterial chemoembolization (TACE) for multiple HCCs should be further clarified.
We retrospectively enrolled 1065 patients with multiple HCCs. Among them, 294 received surgical resection, 367 received transarterial chemoembolization (TACE), and 404 received chemotherapy or supportive care. Three staging systems (TNM, CLIP, and BCLC) were used for comparison of stage-specific survival between different treatment modalities.
The median survival of multiple HCC patients who received surgical resection was 37.9 months, while it was 17.3 months in TACE group, and 2.8 months in supportive group (P < .001). The 1-year, 3-year, 5-year survival rates for surgical group were 77.4%, 51.9%, and 36.6%, respectively. Kaplan-Meier survival analysis demonstrated that patients who received surgical resections had the best survival, followed by TACE and supportive care. For patients of the same stage, surgical resection yields better results than TACE. Surgery could offer better survival than TACE for patients either within or beyond Milan's criteria.
Our results indicate that if patients have preserved liver functions, hepatic resection is helpful, even for patients with multiple HCCs.
根据目前肝细胞癌（HCC）的治疗指南，多发性HCC通常不适合手术切除。然而，多发性HCC患者仍有可能进行手术切除。肝切除与经动脉化疗栓塞术（TACE）在多发性HCC治疗中的作用应进一步明确。
我们回顾性纳入了1065例多发性HCC患者。其中，294例接受了手术切除，367例接受了经动脉化疗栓塞术（TACE），404例接受了化疗或支持治疗。使用三种分期系统（TNM、CLIP和BCLC）比较不同治疗方式之间的阶段特异性生存率。
接受手术切除的多发性HCC患者的中位生存期为37.9个月，而TACE组为17.3个月，支持治疗组为2.8个月（P <.001）。手术组的1年、3年、5年生存率分别为77.4%、51.9%和36.6%。Kaplan-Meier生存分析表明，接受手术切除的患者生存率最高，其次是TACE和支持治疗。对于同一分期的患者，手术切除的效果优于TACE。对于符合或不符合米兰标准的患者，手术切除比TACE能提供更好的生存。
我们的结果表明，如果患者肝功能良好，肝切除是有益的，即使对于多发性HCC患者也是如此。
