Division of Gastroenterologic and General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
J Gastrointest Surg. 2012 Aug;16(8):1516-23. doi: 10.1007/s11605-012-1918-2. Epub 2012 May 30.
We investigated the role of operative therapy in non-cirrhotic patients who developed metastatic hepatocellular carcinoma (HCC).
This retrospective cohort study included consecutive non-cirrhotic patients with metastatic HCC after a prior hepatectomy treated between 1990 and 2009. Patients were stratified by operative therapy (resection, ablation, transcatheter therapy). Kaplan-Meier analyses with log-rank comparisons tested effects of operative therapy on overall survival (OS) and progression-free survival (PFS).
Of 195 non-cirrhotic patients treated for HCC during the study period, 98 [median age 65, interquartile range (IQR) 53-71; 55 % male] subsequently developed metastatic HCC (55 intrahepatic only). Median time to development of metastases after the index operation was 10 months (IQR 5-20 months); median number of metastases was 3 (IQR 2-7). Half of these patients (n = 50) underwent operative treatment of metastases; 20 (40 %) underwent metastasectomy, 18 (36 %) ablation, and 12 (24 %) transcatheter therapy. Operative therapy was associated with improved OS (p < 0.001). Resection or ablation was associated with improved PFS and OS compared to transcatheter therapy (all p ≤ 0.006). Nine patients (seven resection, two ablation) are disease free at a median of 50 months (IQR 24-80 months) posttreatment.
Resection and ablation are associated with an improved PFS and long-term OS and should be considered in select patients with metastatic HCC.
本研究旨在探讨非肝硬化患者发生转移性肝细胞癌（HCC）后接受手术治疗的作用。
本回顾性队列研究纳入了 1990 年至 2009 年间接受过肝切除术治疗的非肝硬化、且术后发生转移性 HCC 的连续性患者。根据手术治疗（切除术、消融术、经导管治疗）对患者进行分层。采用 Kaplan-Meier 分析和对数秩检验检测手术治疗对总生存期（OS）和无进展生存期（PFS）的影响。
在研究期间，195 例非肝硬化 HCC 患者接受了治疗，其中 98 例（中位年龄 65 岁，四分位距 53-71 岁；55%为男性）随后发生了转移性 HCC（55 例为肝内转移）。从指数手术后到发生转移的中位时间为 10 个月（四分位距 5-20 个月）；转移灶的中位数为 3 个（四分位距 2-7 个）。这些患者中有一半（n=50）接受了转移性病变的手术治疗；20 例（40%）接受了转移灶切除术，18 例（36%）接受了消融术，12 例（24%）接受了经导管治疗。手术治疗与 OS 改善相关（p<0.001）。与经导管治疗相比，切除术或消融术与改善的 PFS 和 OS 相关（均 p≤0.006）。9 例患者（7 例切除术，2 例消融术）在治疗后中位时间为 50 个月（四分位距 24-80 个月）时无疾病。
切除术和消融术与改善的 PFS 和长期 OS 相关，应在选择的转移性 HCC 患者中考虑。
