Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
Cancer. 2012 Apr 1;118(7):1838-44. doi: 10.1002/cncr.26501. Epub 2011 Aug 25.
The incidence of hepatocellular carcinoma (HCC) is rising, and the options for surgical therapy of HCC have evolved recently, but use of surgical therapy has not been characterized on a representative, nationwide basis. We quantified trends in use, mortality, and patient and hospital characteristics for 3 surgical therapies for HCC (resection, ablation, and transplantation) in the United States from 1998 to 2008.
Hospital discharge data from the Nationwide Inpatient Sample were used to quantify procedure-related data for each year. Trends over time were summarized as the average annual percent change (AAPC) and corresponding 95% confidence interval (CI).
The number of surgical procedures for HCC increased from 1416 to 6769 (AAPC, 13.5%; 95% CI, 10.2%-16.8%). Volumes increased for all surgical procedures, most notably for ablation (AAPC, 17.3%; 95% CI, 6.6%-29.2%) and transplantation (AAPC, 20.9%; 95% CI, 14.1%-28.1%). When analyzed as a proportion of total procedures, there were declines in the relative use of major hepatectomy (35% to 16%; AAPC, -7.2%, 95% CI, -8.8% to -5.6%) and wedge resection (37% to 22%; AAPC, -4.8%; 95% CI, -6.2% to -3.4%), while the proportion accounted for by transplantation increased (16% to 35%; AAPC, 4.4%; 95% CI, 0.2%-8.9%). Inpatient mortality decreased for each procedure individually and overall from 7.3% to 4.6% (AAPC, -7.7%; 95% CI, -10.8% to -4.5%), despite increasing age and comorbidity burden.
The use of surgical therapy for HCC has increased dramatically over the last decade, with a relative shift away from liver resection and toward liver transplantation. These therapeutic modalities must be better targeted to make the most appropriate use of limited health care resources.
肝细胞癌（HCC）的发病率正在上升，HCC 的手术治疗选择最近也有了发展，但尚未在具有代表性的全国范围内对手术治疗的应用情况进行描述。我们在美国对 1998 年至 2008 年间 HCC 的 3 种手术治疗方法（切除术、消融术和肝移植术）的应用情况、死亡率以及患者和医院特征进行量化分析。
利用全国住院患者样本中的住院数据，对每年与手术相关的数据进行量化。采用平均年度百分比变化（AAPC）及其相应的 95%置信区间（CI）来总结随时间变化的趋势。
HCC 手术数量从 1416 例增加到 6769 例（AAPC，13.5%；95%CI，10.2%-16.8%）。所有手术数量都有所增加，尤以消融术（AAPC，17.3%；95%CI，6.6%-29.2%）和肝移植术（AAPC，20.9%；95%CI，14.1%-28.1%）增加最为显著。如果将手术数量分析为总手术数量的比例，那么大范围肝切除术（35%降至 16%；AAPC，-7.2%；95%CI，-8.8%至-5.6%）和楔形切除术（37%降至 22%；AAPC，-4.8%；95%CI，-6.2%至-3.4%）的相对应用比例有所下降，而肝移植术的比例有所增加（16%升至 35%；AAPC，4.4%；95%CI，0.2%-8.9%）。尽管患者年龄和合并症负担增加，但每种手术的住院死亡率以及总体住院死亡率均从 7.3%降至 4.6%（AAPC，-7.7%；95%CI，-10.8%至-4.5%）。
在过去的十年中，HCC 的手术治疗应用已大幅增加，治疗方式相对从肝切除术转向肝移植术。这些治疗方式必须更有针对性，以最合理地利用有限的医疗资源。
