UOC di Chirurgia 2 (Chirurgia Epato-bilio-pancreatica e Digestiva), A.O. San Paolo, Dipartimento di Medicina, Chirurgia ed Odontoiatria, Università degli Studi di Milano, Milan, Italy.
Ann Surg Oncol. 2012 Feb;19(2):426-34. doi: 10.1245/s10434-011-1845-6. Epub 2011 Jul 6.
Our aim was to assess the capability of Barcelona Clinic Liver Cancer (BCLC) staging system in allocating stage A patients to hepatic resection (HR) and the effect on survival.
We enrolled 132 patients with hepatocellular carcinoma (HCC) amenable to HR. All patients underwent ultrasound (US)-guided anatomical resection (≤2 segments) and then postoperative results were evaluated.
Results showed 95% of patients were Child A, 49% in BCLC A1, 21% in A2, 6% in A3, and 24% in A4. No 30-day mortality occurred. Overall survival got worse from A1 to A4 (P = 0.0271), while no differences were found in Childs A patients with or without portal hypertension (P = 0.1674). Multivariate analysis (Cox model) shows that only AFP (<20 ng/ml) was an independent predictor of survival: If the AFP is incorporated in BCLC staging system (all A1 and A2 patients with abnormal AFP levels were included in A3 subgroup), 5-year survival rate including normal AFP for A1 was 57% and for A2 was 65%, whereas the survival rates impaired in the worst candidates (5-year survival rate including AFP abnormal for A3 and A4 was 36%; P = 0.002). So, introducing AFP in BCLC classification it is possible to simplify the algorithm in only 2 classes, well-separated in survival curves (class 1 [AFP-]: 60%; class 2 [AFP+]: 37%; P = 0.0001).
Our experience stressed the high value of BCLC system in staging of patients with HCC, but underlined that in selected patients (normal AFP) even A2 group may benefit from HR with a good survival.
本研究旨在评估巴塞罗那临床肝癌（BCLC）分期系统在分配 A 期患者行肝切除术（HR）方面的能力及其对生存的影响。
我们纳入了 132 例适合 HR 的肝细胞癌（HCC）患者。所有患者均接受超声（US）引导下解剖性切除术（≤2 个节段），然后评估术后结果。
结果显示，95%的患者为 Child A 级，49%为 BCLC A1 期，21%为 A2 期，6%为 A3 期，24%为 A4 期。无 30 天死亡病例。总体生存情况从 A1 期到 A4 期逐渐恶化（P = 0.0271），而无门静脉高压的 Child A 患者与有门静脉高压的患者之间生存情况无差异（P = 0.1674）。多变量分析（Cox 模型）显示，只有 AFP（<20ng/ml）是生存的独立预测因素：如果将 AFP 纳入 BCLC 分期系统（所有 AFP 水平异常的 A1 和 A2 期患者均归入 A3 亚组），则 AFP 正常的 A1 期 5 年生存率为 57%，A2 期为 65%，而最差候选者的生存情况恶化（A3 和 A4 期 AFP 异常患者的 5 年生存率为 36%；P = 0.002）。因此，在 BCLC 分类中引入 AFP，可以将算法简化为仅 2 个类别，在生存曲线中得到很好的区分（AFP-类[AFP-]：60%；AFP+类[AFP+]：37%；P = 0.0001）。
我们的经验强调了 BCLC 系统在 HCC 患者分期中的重要价值，但也强调了在某些患者（AFP 正常）中，即使 A2 期患者也可能从 HR 中获益，获得良好的生存。
