Wörns Marcus A, Bosslet Timon, Victor Anja, Koch Sandra, Hoppe-Lotichius Maria, Heise Michael, Hansen Torsten, Pitton Michael B, Niederle Ina M, Schuchmann Marcus, Weinmann Arndt, Düber Christoph, Galle Peter R, Otto Gerd
Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
Scand J Gastroenterol. 2012 Jun;47(6):718-28. doi: 10.3109/00365521.2012.677952. Epub 2012 Apr 4.
To report the outcome of patients with hepatocellular carcinoma (HCC) in non-cirrhotic liver depending on the mode of primary treatment and to define clinicopathological factors influencing patients' prognosis.
A retrospective analysis of an unselected cohort of 105 patients was performed. Overall survival (OS) was estimated by the Kaplan-Meier method and potentially prognostic factors were analyzed in Cox regression models.
OS of the whole cohort at 1, 3, and 5 years was 66%, 47%, and 29%, respectively. Tobacco consumption, ECOG >0, macroscopic vascular invasion, continuous tumor diameter, and treatment other than resection were predictors of decreased OS in the whole cohort. Resection was performed in 64% of patients with 1-, 3-, and 5-year OS rates of 84%, 69%, and 42%, respectively. Siderosis and BCLC stage were associated with decreased OS after resection. Recurrence occurred in 57% of patients with 1-, 3-, and 5-year disease-free survival (DFS) rates of 63%, 39%, and 31%, respectively. Viral hepatitis and macroscopic vascular invasion were associated with decreased DFS. One-, 3-, and 5-year OS rates in patients with non-surgical approaches (transarterial chemoembolization, systemic therapy, best supportive care) were 38%, 11%, and 7%, respectively. Tobacco consumption and Okuda stage were associated with decreased OS in these patients.
OS and DFS of patients with HCC in non-cirrhotic liver depend most notably on tumor-related, demographic, and etiological factors. Features of the non-neoplastic liver tissue play only a minor role. Liver resection leads to a significantly better prognosis than non-surgical treatment approaches.
根据原发性治疗方式报告非肝硬化性肝肝细胞癌（HCC）患者的预后情况，并确定影响患者预后的临床病理因素。
对105例未经选择的患者队列进行回顾性分析。采用Kaplan-Meier法估计总生存期（OS），并在Cox回归模型中分析潜在的预后因素。
整个队列1年、3年和5年的OS分别为66%、47%和29%。在整个队列中，吸烟、美国东部肿瘤协作组（ECOG）评分>0、肉眼可见的血管侵犯、肿瘤持续直径以及除手术切除以外的治疗是OS降低的预测因素。64%的患者接受了手术切除，其1年、3年和5年的OS率分别为84%、69%和42%。铁质沉着症和巴塞罗那临床肝癌（BCLC）分期与切除术后OS降低相关。57%的患者出现复发，其1年、3年和5年的无病生存期（DFS）率分别为63%、39%和31%。病毒性肝炎和肉眼可见的血管侵犯与DFS降低相关。采用非手术方法（经动脉化疗栓塞、全身治疗、最佳支持治疗）的患者1年、3年和5年的OS率分别为38%、11%和7%。在这些患者中吸烟和奥田分期与OS降低相关。
非肝硬化性肝HCC患者的OS和DFS最主要取决于肿瘤相关、人口统计学和病因学因素。非肿瘤性肝组织的特征仅起次要作用。肝切除比非手术治疗方法的预后明显更好。
