Department of Surgery, Liver Tumor Center, Johns Hopkins University School of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Surg Oncol. 2012 Sep;19(9):2897-907. doi: 10.1245/s10434-012-2336-0. Epub 2012 Apr 3.
Data on infiltrating hepatocellular carcinoma (HCC) are limited. We sought to define treatment and outcome of patients treated with infiltrating HCC compared with patients who had advanced multifocal HCC.
Between January 2000 and July 2011, a total of 147 patients with advanced HCC were identified from the Johns Hopkins Hospital database (infiltrative, n = 75; multifocal, n = 72). Clinicopathologic data were compared by HCC subtype.
Patients with infiltrating HCC had higher alfa-fetoprotein levels (median infiltrative, 326.5 ng/mL vs. multifocal, 27.0 ng/mL) and larger tumors (median size, infiltrating, 9.2 cm vs. multifocal, 5.5 cm) (P < 0.05). Imaging failed to reveal a discrete lesion in 42.7 % of patients with infiltrating HCC. Most infiltrating HCC lesions presented as hypointense on T1-weighted images (55.7 %) and hyperintense on T2-weighted images (80.3 %). Among patients with infiltrating HCC, most (64.0 %) were treated with intra-arterial therapy (IAT), and periprocedural morality was 2.7 %. Patients treated with IAT had longer survival versus patients receiving best support care (median survival, IAT, 12 months vs. best supportive care, 3 months; P = 0.001). Survival after IAT was similar among patients treated with infiltrating HCC versus multifocal HCC (hazard ratio 1.29, 95 % confidence interval 0.82-2.03; P = 0.27). Among infiltrating HCC patients, pretreatment bilirubin >2 mg/dL and alfa-fetoprotein >400 ng/mL were associated with worse survival after IAT (P < 0.05). Patients with progressive disease after IAT had higher risk of death versus patients who had stable/responsive disease (hazard ratio 3.53, 95 % confidence interval 1.49-8.37; P = 0.004).
Patients with infiltrative HCC often present without a discrete lesion on imaging. IAT for infiltrative HCC was safe and was associated with survival comparable to IAT outcomes for patients with multifocal HCC. Infiltrative HCC morphology is not a contraindication to IAT therapy in select patients.
关于浸润性肝细胞癌（HCC）的数据有限。我们旨在定义与多发性晚期 HCC 患者相比，接受浸润性 HCC 治疗的患者的治疗和结局。
2000 年 1 月至 2011 年 7 月，我们从约翰霍普金斯医院数据库中确定了 147 名晚期 HCC 患者（浸润性，n = 75；多发性，n = 72）。通过 HCC 亚型比较临床病理数据。
浸润性 HCC 患者的甲胎蛋白水平较高（中位数，浸润性，326.5ng/mL；多发性，27.0ng/mL），肿瘤较大（中位数，浸润性，9.2cm；多发性，5.5cm）（P < 0.05）。42.7%的浸润性 HCC 患者的影像学检查未能发现明确的病变。大多数浸润性 HCC 病变在 T1 加权图像上呈低信号（55.7%），在 T2 加权图像上呈高信号（80.3%）。在浸润性 HCC 患者中，大多数（64.0%）接受了经动脉治疗（IAT），围手术期死亡率为 2.7%。与接受最佳支持治疗的患者相比，接受 IAT 治疗的患者生存时间更长（中位生存时间，IAT，12 个月；最佳支持治疗，3 个月；P = 0.001）。接受 IAT 治疗的浸润性 HCC 患者与多发性 HCC 患者的生存时间相似（风险比 1.29，95%置信区间 0.82-2.03；P = 0.27）。在浸润性 HCC 患者中，治疗前胆红素 >2mg/dL 和甲胎蛋白 >400ng/mL 与 IAT 后生存较差相关（P < 0.05）。IAT 后疾病进展的患者与疾病稳定/有反应的患者相比，死亡风险更高（风险比 3.53，95%置信区间 1.49-8.37；P = 0.004）。
浸润性 HCC 患者的影像学检查常无明确病变。浸润性 HCC 的 IAT 是安全的，与多发性 HCC 患者的 IAT 结局相当。在选择的患者中，浸润性 HCC 的形态并不是 IAT 治疗的禁忌症。
