Service of Hepatobiliary Surgery and Liver Transplantation, Saint-Antoine Hospital, Assistance Publique, Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.
World J Surg. 2012 Nov;36(11):2684-91. doi: 10.1007/s00268-012-1723-9.
Long-term outcomes of patients who experience recurrence after liver resection (LR) of hepatocellular carcinoma (HCC) are uncertain.
The characteristics of 58 patients were obtained from a retrospective database at two time points: primary resection and recurrence. Patterns of recurrence, treatment strategies, and long-term survival rates were analyzed.
The recurrence was inside the Milan criteria (Milan+) in 19 patients (32.7 %), 11 of whom were already eligible for a liver transplant (LT) at the time of primary liver resection (LR). Treatment of the recurrence included the following procedures: salvage LT (n = 6; 10.3 %), repeat LR (n = 7; 12.1 %), percutaneous radiofrequency ablation (RFA) and/or transarterial chemoembolization (TACE) (n = 24; 41.3 %), systemic chemotherapy (n = 15; 25.8 %), and best supportive care (n = 12; 20.7 %). With a mean follow-up of 26.9 ± 27.9 months, the overall 1-, 3-, and 5-year survival rates of the 58 patients with HCC recurrence after primary LR were 57.3, 42.5, and 35.3 %, respectively. In the multivariate analysis the presence of esophageal varices (p = 0.001), an AFP level >200 μg/L (p = 0.03) and a Milan- recurrence pattern (p = 0.05) were independent predictors of decreased survival. The overall 5-year survival of patients who experienced Milan+ recurrence was comparable to that of Milan+ patients who underwent primary LR (62.5 % vs. 66.3 %, p = 0.48).
Aggressive management of recurrent HCC after upfront LR improves patient survival. The pattern of recurrence is an independent predictor of survival which can be used as a selection criterion for salvage LT.
经历肝癌（HCC）肝切除（LR）后复发的患者的长期预后尚不确定。
从两个时间点的回顾性数据库中获得了 58 例患者的特征：初次切除和复发。分析了复发模式、治疗策略和长期生存率。
19 例（32.7%）复发位于米兰标准内（米兰+），其中 11 例在初次肝切除（LR）时已符合肝移植（LT）标准。复发性 HCC 的治疗包括以下程序：挽救性 LT（n = 6；10.3%）、再次 LR（n = 7；12.1%）、经皮射频消融（RFA）和/或经动脉化疗栓塞（TACE）（n = 24；41.3%）、全身化疗（n = 15；25.8%）和最佳支持治疗（n = 12；20.7%）。58 例 HCC 患者在初次 LR 后复发，平均随访 26.9±27.9 个月，其总体 1、3 和 5 年生存率分别为 57.3%、42.5%和 35.3%。多因素分析显示，存在食管静脉曲张（p=0.001）、AFP 水平＞200μg/L（p=0.03）和米兰复发模式（p=0.05）是生存时间缩短的独立预测因素。经历米兰+复发的患者的总体 5 年生存率与接受初次 LR 的米兰+患者相当（62.5% vs. 66.3%，p=0.48）。
积极治疗 upfront LR 后复发性 HCC 可提高患者生存率。复发模式是生存的独立预测因素，可作为挽救性 LT 的选择标准。
