Nathan Hari, Schulick Richard D, Choti Michael A, Pawlik Timothy M
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
Ann Surg. 2009 May;249(5):799-805. doi: 10.1097/SLA.0b013e3181a38eb5.
To identify clinicopathologic factors that predict survival following hepatectomy in patients with early hepatocellular carcinoma (HCC).
Although surgical resection of early HCC is thought to be associated with a good outcome, factors predictive of prognosis following resection of these tumors remain ill-defined.
The Surveillance, Epidemiology, and End Results database was used to identify patients with histologically confirmed early HCC (< or =5 cm and no nodal involvement, metastases, or major vascular invasion) who underwent surgical resection (not ablation or transplantation) between 1988 and 2005. Prognostic factors were evaluated using Kaplan-Meier curves and Cox proportional hazards models.
The study included 788 patients. Median tumor size was 3.2 cm, and 20% of patients had tumors < or =2 cm. Most HCC lesions were solitary (74%) and had no evidence of vascular invasion (82%). Following surgery, overall median and 5-year survival were 45 months and 39%, respectively. After adjusting for demographic factors and histological grade, tumor size >2 cm (hazard ratio [HR]: 1.51), multifocal tumors (HR: 1.51), and vascular invasion (HR: 1.44) remained independent predictors of poor survival (all P < 0.05). Based on these findings, a prognostic scoring system was developed that allotted 1 point each for these factors. Patients with early HCC could be stratified into 3 distinct prognostic groups (median and 5-year survival, respectively): 0 points (70 months, 55%), 1 point (52 months, 42%), and > or =2 points (24 months, 29%) (P < 0.001).
Although early HCC is generally associated with a good prognosis, pathologic factors can still be used to stratify patients with respect to survival after resection. These data emphasize the importance of pathologic staging even in small HCC.
确定预测早期肝细胞癌（HCC）患者肝切除术后生存的临床病理因素。
尽管早期HCC的手术切除被认为预后良好，但这些肿瘤切除术后预测预后的因素仍不明确。
利用监测、流行病学和最终结果数据库，确定1988年至2005年间接受手术切除（而非消融或移植）、组织学确诊为早期HCC（≤5 cm且无淋巴结受累、转移或主要血管侵犯）的患者。使用Kaplan-Meier曲线和Cox比例风险模型评估预后因素。
该研究纳入788例患者。肿瘤中位大小为3.2 cm，20%的患者肿瘤≤2 cm。大多数HCC病变为单发（74%），且无血管侵犯证据（82%）。手术后，总体中位生存期和5年生存率分别为45个月和39%。在调整人口统计学因素和组织学分级后，肿瘤大小>2 cm（风险比[HR]：1.51）、多灶性肿瘤（HR：1.51）和血管侵犯（HR：1.44）仍然是生存不良的独立预测因素（均P<0.05）。基于这些发现，开发了一种预后评分系统，这些因素各分配1分。早期HCC患者可分为3个不同的预后组（中位生存期和5年生存率，分别）：0分（70个月，55%）、1分（52个月，42%）和≥2分（24个月，29%）（P<0.001）。
尽管早期HCC通常预后良好，但病理因素仍可用于对切除术后患者的生存进行分层。这些数据强调了即使在小肝癌中病理分期的重要性。
