肝硬化患者单发肝癌：肝切除术还是肝移植？基于意向治疗的长期结果。
Single HCC in cirrhotic patients: liver resection or liver transplantation? Long-term outcome according to an intention-to-treat basis.
机构信息
Department of HBP Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
出版信息
Ann Surg Oncol. 2013 Apr;20(4):1194-202. doi: 10.1245/s10434-012-2655-1. Epub 2012 Sep 11.
BACKGROUND
Compensated cirrhotic patients with single hepatocellular carcinoma (HCC) ≤5 cm may benefit from both liver resection (LR) and liver transplantation (LT); however, the better 10-year actuarial survival of the two treatments remains unclear. We aimed to assess the long-term outcome of cirrhotic patients with single HCC ≤5 cm treated either with LR or LT on an intention-to-treat basis.
METHODS
A total of 217 cirrhotic patients with single HCC ≤5 cm were evaluated at our department: 95 were treated with LR (LR group), and 122 were included on the waiting list for LT (LT group). Patients in the LR group were divided into very early HCC (tumor size ≤2 cm) and early HCC (tumor size >2 cm). Median follow-up was 5.3 (range 0.1-18) years.
RESULTS
Tumor recurrence was 72 % in the LR group versus 16 % in the LT group (p < 0.001). 1-, 5-, and 10-year cumulative risk of recurrence was 18, 69, and 83 % in the LR group versus 4, 18, and 20 % in the LT group (p < 0.001). Ten-year actuarial survival was 33 % in the LR group versus 49 % in the LT group (p = 0.002). At HCC recurrence, 27.3 % were included on the waiting list for salvage transplantation (very early HCC group) versus 15.1 % (early HCC group) (p = 0.2). After salvage transplantation, HCC recurrence was 0 % (very early HCC group) versus 40 % (early HCC group) (p = 0.2). No significant differences were observed in 1-, 5-, and 10-year actuarial survival between the very early HCC group and the LT group (95, 55, and 50 % vs. 82, 62, and 50 %).
CONCLUSIONS
LR should be the treatment of choice for cirrhotic patients with very early HCC.
背景
对于单个最大直径不超过 5cm 的代偿性肝硬化肝癌患者，肝切除术（LR）和肝移植术（LT）都可能会带来益处；然而，这两种治疗方法的 10 年总生存率孰优孰劣仍不清楚。我们旨在评估以意向治疗为基础，对单个最大直径不超过 5cm 的代偿性肝硬化肝癌患者，分别采用 LR 或 LT 治疗的长期结局。
方法
本研究共评估了我科 217 例单个最大直径不超过 5cm 的代偿性肝硬化肝癌患者：95 例接受了 LR（LR 组），122 例列入 LT 候补名单（LT 组）。LR 组患者再根据肿瘤大小分为极早期 HCC（肿瘤直径≤2cm）和早期 HCC（肿瘤直径＞2cm）。中位随访时间为 5.3 年（范围 0.1-18 年）。
结果
LR 组的肿瘤复发率为 72%，而 LT 组为 16%（p<0.001）。LR 组 1、5 和 10 年累积复发风险分别为 18%、69%和 83%，LT 组分别为 4%、18%和 20%（p<0.001）。LR 组的 10 年总生存率为 33%，LT 组为 49%（p=0.002）。在 HCC 复发时，27.3%的患者（极早期 HCC 组）被列入挽救性移植候补名单，而 15.1%（早期 HCC 组）（p=0.2）。在挽救性移植后，极早期 HCC 组 HCC 复发率为 0%，而早期 HCC 组为 40%（p=0.2）。极早期 HCC 组和 LT 组的 1、5 和 10 年总生存率无显著差异（分别为 95%、55%和 50% vs. 82%、62%和 50%）。
结论
对于极早期 HCC 患者，LR 应作为首选治疗方法。
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