Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
PLoS One. 2013 Apr 12;8(4):e59040. doi: 10.1371/journal.pone.0059040. Print 2013.
In the treatment of hepatocellular carcinoma (HCC), hepatic resection has the advantage over radiofrequency ablation (RFA) in terms of systematic removal of a hepatic segment.
We enrolled 303 consecutive patients of a single naïve HCC that had been treated by RFA at The University of Tokyo Hospital from 1999 to 2004. Recurrence was categorized as either intra- or extra-subsegmental as according to the Couinaud's segment of the original nodule. To assess the relationship between the subsegments of the original and recurrent nodules, we calculated the kappa coefficient. We assessed the risk factors for intra- and extra-subsegmental recurrence independently using univariate and multivariate Cox proportional hazard regression. We also assessed the impact of the mode of recurrence on the survival outcome.
During the follow-up period, 201 patients in our cohort showed tumor recurrence distributed in a total of 340 subsegments. Recurrence was categorized as exclusively intra-subsegmental, exclusively extra-subsegmental, and simultaneously intra- and extra-subsegmental in 40 (20%), 110 (55%), and 51 (25%) patients, respectively. The kappa coefficient was measured at 0.135 (95% CI, 0.079-0.190; P<0.001). Multivariate analysis revealed that of the tumor size, AFP value and platelet count were all risk factors for both intra- and extra-subsegmental recurrence. Of the patients in whom recurrent HCC was found to be exclusively intra-subsegmental, extra-subsegmental, and simultaneously intra- and extra-subsegmental, 37 (92.5%), 99 (90.8%) and 42 (82.3%), respectively, were treated using RFA. The survival outcomes after recurrence were similar between patients with an exclusively intra- or extra-subsegmental recurrence.
The effectiveness of systematic subsegmentectomy may be limited in the patients with both HCC and chronic liver disease who frequently undergo multi-focal tumor recurrence.
在肝细胞癌（HCC）的治疗中，肝切除术相对于射频消融（RFA）具有系统性切除肝段的优势。
我们纳入了 1999 年至 2004 年在东京大学医院接受 RFA 治疗的 303 例初治单灶 HCC 患者。根据原始结节的 Couinaud 节段，复发分为节内或节外。为了评估原始和复发性结节的亚段之间的关系，我们计算了 Kappa 系数。我们使用单因素和多因素 Cox 比例风险回归分别独立评估节内和节外复发的危险因素。我们还评估了复发模式对生存结果的影响。
在随访期间，我们队列中的 201 例患者显示肿瘤复发分布在总共 340 个亚段中。复发分为单纯节内、单纯节外和同时节内和节外，分别为 40 例（20%）、110 例（55%）和 51 例（25%）。Kappa 系数为 0.135（95%CI，0.079-0.190；P<0.001）。多因素分析显示，肿瘤大小、AFP 值和血小板计数均是节内和节外复发的危险因素。在复发性 HCC 被发现为单纯节内、单纯节外和同时节内和节外的患者中，分别有 37（92.5%）、99（90.8%）和 42（82.3%）例患者接受了 RFA 治疗。复发后，仅节内或节外复发患者的生存结果相似。
在患有 HCC 和慢性肝病的患者中，系统的亚段切除术的效果可能有限，这些患者经常发生多灶性肿瘤复发。
