Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-machi, Itabashi-ku, Tokyo 173-8610, Japan.
J Hepatol. 2013 Feb;58(2):306-11. doi: 10.1016/j.jhep.2012.09.026. Epub 2012 Oct 9.
BACKGROUND & AIMS: Early treatment has been recommended for hepatocellular carcinoma (HCC) due to its high cure rate. However, the reported survival benefits of treating early HCC may be affected by lead time.
Early HCC was defined as a well-differentiated cancer containing Glisson's triad (carcinoma in situ). We applied the concept of lead time to chronic liver disease, which is originally the length of time between screen-detected and symptom-detected disease. To evaluate prolongation of survival with treatment of early HCC, survivals of patients with early and overt HCCs smaller than 2.0 cm treated with liver resection were compared. To calculate lead time and survival benefit of liver resection, survivals of untreated early and overt HCC patients were compared.
After liver resection, median overall survival of 46 patients with early HCC (8.8 years; 95% CI, 7.2-11.2) was significantly longer than that of the 202 with overt HCC (6.8 years; 95% CI, 6.2-8.3, p = 0.0257). The prolongation in survival time with liver resection for early HCC was 34.7 (95% CI, 22.1-46.5) months. On the other hand, comparing liver resection and natural history, the survival benefits of surgery for 12 patients with early and 16 with overt HCC were 74.7 (95% CI, 51.9-97.4) and 73.4 (95% CI, 57.9-88.9) months, respectively. Consequently, the lead time and survival benefit with resection for early HCC were estimated as 33.4 (95% CI, 18.9-47.8) and 1.3 (95% CI, -22.1-24.7) months, respectively.
Survival benefit of resection for early HCC is marginal because of a long lead time, and early HCC is therefore not a target lesion for surgery.
由于肝癌（HCC）的高治愈率，建议早期治疗。然而，早期 HCC 治疗的生存获益可能受到领先时间的影响。
早期 HCC 定义为含有 Glisson 三联体（癌前病变）的分化良好的癌症。我们将领先时间的概念应用于慢性肝病，这原本是筛查发现和症状发现疾病之间的时间长度。为了评估早期 HCC 治疗对延长生存时间的影响，比较了接受肝切除术治疗的小于 2.0cm 的早期和显性 HCC 患者的生存情况。为了计算肝切除术的领先时间和生存获益，比较了未经治疗的早期和显性 HCC 患者的生存情况。
肝切除术后，46 例早期 HCC 患者的中位总生存期为 8.8 年（95%CI，7.2-11.2），明显长于 202 例显性 HCC 患者的 6.8 年（95%CI，6.2-8.3，p=0.0257）。肝切除术治疗早期 HCC 可延长 34.7 个月（95%CI，22.1-46.5）。另一方面，与自然史相比，12 例早期 HCC 和 16 例显性 HCC 患者行手术治疗的生存获益分别为 74.7（95%CI，51.9-97.4）和 73.4（95%CI，57.9-88.9）个月。因此，早期 HCC 切除的领先时间和生存获益分别估计为 33.4（95%CI，18.9-47.8）和 1.3（95%CI，-22.1-24.7）个月。
由于领先时间较长，肝切除术治疗早期 HCC 的生存获益有限，因此早期 HCC 不是手术的目标病变。
