Arnaoutakis Dean J, Mavros Michael N, Shen Feng, Alexandrescu Sorin, Firoozmand Amin, Popescu Irinel, Weiss Matthew, Wolfgang Christopher L, Choti Michael A, Pawlik Timothy M
Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Ann Surg Oncol. 2014 Jan;21(1):147-154. doi: 10.1245/s10434-013-3211-3.
Hepatocellular carcinoma (HCC) primarily affects patients with a cirrhotic liver. Reports on the characteristics of patients with HCC in noncirrhotic liver, as well as predictors of recurrence and survival, are scarce.
Between 1992 and 2011, 334 patients treated for HCC in noncirrhotic liver were identified from three major hepatobiliary centers. Clinicopathological characteristics were analyzed and independent predictors of recurrence and overall survival were identified using Cox proportional hazards models.
Median patient age was 58 years and 77 % were male. Most patients had a solitary (81 %) and poorly or undifferentiated tumor (56 %); median size was 6.5 cm. The majority of patients (96 %) underwent liver resection (microscopically negative margins in 94 %), whereas a few had transarterial chemoembolization or transplantation (4 %). Median recurrence-free survival (RFS) was 2.5 years, and 1- and 5-year RFS was 71.1, and 35 %, respectively. Elevated alkaline phosphatase levels [hazards ratio (HR) = 1.82], poor tumor differentiation (HR = 1.4), macrovascular invasion (HR = 2.18), and the presence of satellite lesions (HR = 1.9), or intrahepatic metastases (HR = 2.59) were independently associated with shorter RFS; in contrast, an intact tumor capsule independently prolonged RFS (HR = 0.46). Median overall survival was 5.9 years, and 1- and 5-year overall survival was 86.9, and 54.5 %, respectively. Tumor size ≥5 cm (HR = 2.27), macrovascular (HR = 2.72) or adjacent organ invasion (HR = 3.34), and satellite lesions (HR = 2.18) were independently associated with shorter overall survival, whereas an intact tumor capsule showed a protective effect (HR = 0.51).
Following resection of HCC in the setting of no cirrhosis, more than one-half of patients were alive after 5 years. However, even among patients with no cirrhosis, recurrence was common. Factors associated with RFS and overall survival included tumor characteristics, such as tumor capsule, satellite lesions, and vascular invasion.
肝细胞癌（HCC）主要影响肝硬化患者。关于非肝硬化肝脏中HCC患者的特征以及复发和生存预测因素的报道很少。
1992年至2011年期间，从三个主要肝胆中心确定了334例接受非肝硬化肝脏HCC治疗的患者。分析临床病理特征，并使用Cox比例风险模型确定复发和总生存的独立预测因素。
患者中位年龄为58岁，77%为男性。大多数患者有单个肿瘤（81%）且肿瘤分化差或未分化（56%）；中位大小为6.5厘米。大多数患者（96%）接受了肝切除术（94%切缘镜下阴性），少数患者接受了经动脉化疗栓塞或肝移植（4%）。中位无复发生存期（RFS）为2.5年，1年和5年RFS分别为71.1%和35%。碱性磷酸酶水平升高[风险比（HR）=1.82]、肿瘤分化差（HR = 1.4）、大血管侵犯（HR = 2.18）、存在卫星灶（HR = 1.9）或肝内转移（HR = 2.59）与较短的RFS独立相关；相反，完整的肿瘤包膜可独立延长RFS（HR = 0.46）。中位总生存期为5.9年，1年和5年总生存率分别为86.9%和54.5%。肿瘤大小≥5厘米（HR = 2.27）、大血管（HR = 2.72）或邻近器官侵犯（HR = 3.34）以及卫星灶（HR = 2.18）与较短的总生存期独立相关，而完整的肿瘤包膜显示出保护作用（HR = 0.51）。
在无肝硬化情况下切除HCC后，超过一半的患者5年后仍存活。然而，即使在无肝硬化的患者中，复发也很常见。与RFS和总生存相关的因素包括肿瘤特征，如肿瘤包膜、卫星灶和血管侵犯。
