Service de Chirurgie Digestive et Transplantations, Hôpital Huriez, Rue M. Polonovski, CHU, Univ Nord de France, F-59000 Lille, France.
Eur J Surg Oncol. 2012 Dec;38(12):1189-96. doi: 10.1016/j.ejso.2012.07.112. Epub 2012 Aug 3.
Hepatocellular carcinoma in noncirrhotic liver (NC-HCC) presents usually with large size, which is seen as a contraindication to liver transplantation (LT) or even resection. The objective of our single-center study was to identify prognostic factors following resection of large NC-HCCs and to subsequently devise a treatment strategy (including LT) in selected patients.
From 2000 to 2010, 89 patients who had hepatic resection for NC-HCC (large ≥ 8 cm in 52) were analyzed with regard to pathological findings, postoperative and long-term outcome.
Five patients died postoperatively. After a mean follow-up of 35 ± 30 months, NC-HCC recurred in 36 patients (26/47 survivors in group 8 cm+, 10/37 in group 8 cm-; p = 0.007). Five-year overall (OS) and disease-free survival (DFS) rates were significantly worse for group 8 cm+ (43.4% vs. 89.2% and 39.3% vs. 60.7% for group 8 cm-, p < 0.05). Seven patients underwent re-hepatectomy and/or LT for isolated intrahepatic recurrence, with 5-year DFS of 57.1%. In a multivariate analysis, the factors associated with poor OS and DFS were vascular invasion and tumor size ≥ 8 cm in the overall population and vascular invasion, fibrosis and satellite nodules in group 8 cm+. Adjuvant transarterial chemotherapy was a protective factor in group 8 cm+. In 22 isolated NC-HCC cases with no vascular invasion or fibrosis, tumor size had no impact on five-year DFS (85%).
Although patients with NC-HCC ≥ 8 cm had a poorer prognosis, the absence of vascular invasion or fibrosis was associated with excellent survival, regardless of the tumor size. In recurrent patients, aggressive treatment (including LT) can be considered.
非肝硬化性肝细胞癌（NC-HCC）通常表现为大肿瘤，这被视为肝移植（LT）或甚至切除的禁忌症。我们的单中心研究的目的是确定大 NC-HCC 切除术后的预后因素，并随后为选定的患者制定治疗策略（包括 LT）。
从 2000 年到 2010 年，对 89 例因 NC-HCC（大肿瘤≥8cm 者 52 例）行肝切除术的患者进行了分析，评估了病理发现、术后和长期结果。
术后有 5 例死亡。在平均 35±30 个月的随访后，NC-HCC 在 36 例患者中复发（8cm+组 26/47 例幸存者，8cm-组 10/37 例；p=0.007）。8cm+组的 5 年总生存率（OS）和无病生存率（DFS）显著更差（43.4%比 89.2%和 39.3%比 60.7%；p<0.05）。7 例患者因孤立性肝内复发而行再次肝切除术和/或 LT，5 年 DFS 为 57.1%。多因素分析显示，总体人群中与 OS 和 DFS 不良相关的因素为血管侵犯和肿瘤大小≥8cm，而 8cm+组的相关因素为血管侵犯、纤维化和卫星结节。辅助经动脉化疗在 8cm+组中是保护因素。在 22 例无血管侵犯或纤维化的孤立性 NC-HCC 病例中，肿瘤大小对 5 年 DFS 无影响（85%）。
尽管 NC-HCC≥8cm 的患者预后较差，但无血管侵犯或纤维化与良好的生存相关，而与肿瘤大小无关。在复发患者中，可以考虑积极治疗（包括 LT）。
