Tabrizian Parissa, Jibara Ghalib, Shrager Brian, Schwartz Myron, Roayaie Sasan
*Mount Sinai Medical Center, New York, NY †Department of Urology, the Brookdale's University Hospital and Medical Center, Brooklyn, NY ‡Department of Surgery, Morristown Medical Center, Morristown, NJ; and §Liver Cancer Program, North Shore-LIJ Health Systems, Lenox Hill Hospital, New York, NY.
Ann Surg. 2015 May;261(5):947-55. doi: 10.1097/SLA.0000000000000710.
We sought to determine the factors associated with survival after recurrence of hepatocellular cancer (HCC) after resection and the outcome of our prospectively applied treatment protocol.
Very little is known about the prognosis of HCC that recurs after resection and the outcomes associated with treatments applied to recurrent tumors.
A total of 661 HCC patients undergoing resection from January 1988 to January 2011 were reviewed to identify those with recurrence. Single recurrences with preserved liver function, and no portal hypertension were treated with resection. Patients with multiple intrahepatic tumors or poor liver function and no major comorbidities were listed for transplantation. Patients with up to 3 tumors, each 4 cm or smaller, and not eligible for transplantation, received ablation. Patients not eligible for ablation received embolization. Other treatments such as systemic therapy and radiation were used in remaining patients, but not in a systematic manner.
Recurrent HCC developed in 356 (54%) patients at a median time of 22 months from primary resection. Median survival from time of recurrence to death was 21 months. Variables independently associated with survival from recurrence included time from primary resection to recurrence, alpha-fetoprotein more than 100 ng/mL at recurrence, recurrent tumor larger than 3 cm, BCLC stage at recurrence, and type of treatment rendered for the recurrence. All variables except treatment modality were significantly correlated with characteristics of the original primary tumor.
Most of the variables associated with outcome after recurrence are linked to the primary tumor at initial presentation. Nevertheless, meaningful survival can be achieved with appropriate treatment of recurrent tumors.
我们试图确定肝细胞癌（HCC）切除术后复发与生存相关的因素，以及我们前瞻性应用的治疗方案的结果。
对于HCC切除术后复发的预后以及针对复发性肿瘤的治疗相关结果，人们了解甚少。
回顾了1988年1月至2011年1月期间接受手术切除的661例HCC患者，以确定那些出现复发的患者。肝功能保留且无门静脉高压的单发复发病例接受手术切除治疗。肝内多发肿瘤或肝功能差且无严重合并症的患者被列入肝移植名单。肿瘤数量最多为3个、每个肿瘤直径4 cm或更小且不符合肝移植条件的患者接受消融治疗。不符合消融条件的患者接受栓塞治疗。其余患者采用全身治疗和放疗等其他治疗方法，但并非系统应用。
356例（54%）患者出现复发性HCC，从初次切除到复发的中位时间为22个月。从复发到死亡的中位生存期为21个月。与复发后生存独立相关的变量包括从初次切除到复发的时间、复发时甲胎蛋白大于100 ng/mL、复发性肿瘤大于3 cm、复发时的BCLC分期以及针对复发所采用的治疗类型。除治疗方式外，所有变量均与原发肿瘤的特征显著相关。
复发后与预后相关的大多数变量与初次就诊时的原发肿瘤有关。然而，通过对复发性肿瘤进行适当治疗，可以实现有意义的生存。
