*Department of Surgery, The University of Tokushima, Tokushima, Japan †Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Higashiosaka City, Japan ‡Department of Hepatology and Gastroenterology, Juntendo Shizuoka Hospital, Shizuoka, Japan §Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan ¶Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan ‖Department of Biostatistics, School of Public Health, University of Tokyo, Japan **Department of Pathology, Keio University School of Medicine, Tokyo, Japan ††Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume City, Japan ‡‡Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan §§Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan; and ¶¶Department of Hepatobiliary and Pancreatic Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
Ann Surg. 2015 Mar;261(3):513-20. doi: 10.1097/SLA.0000000000000821.
To compare the prognostic factors and outcomes after hepatic resection among patients with hepatitis B virus (HBV)-positive, hepatitis C virus (HCV)-positive, and negative for hepatitis B surface antigen and hepatitis C antibody, so-called "NBNC"-hepatocellular carcinoma (HCC) using the data from a nationwide survey.
The incidence of NBNC-HCC is rapidly increasing in Japan.
A total of 11,950 patients with HBV-HCC (n = 2194), HCV-HCC (n = 7018), or NBNC-HCC (n = 2738) who underwent a curative hepatic resection were enrolled in this study. The clinicopathological features were compared among the groups. The significant prognostic variables determined by univariate analysis were subjected to a multivariate analysis using a Cox proportional hazard regression model.
Liver function in the HCV-HCC group was significantly worse than that in the HBV-HCC and NBNC-HCC groups. The NBNC-HCC group had significantly more advanced HCC than the HCV-HCC group. The 5-year overall survival rates after hepatectomy in the HBV-HCC, HCV-HCC, and NBNC-HCC groups were 65%, 59%, and 68%, respectively. The 5-year recurrence-free survival (RFS) rates in these 3 groups were 41%, 31%, and 47%, respectively. Stratifying the RFS rates according to the TNM stage showed that the NBNC-HCC group had a significantly better prognosis than the HBV-HCC group in stages II, III, and IVA, and a significantly better prognosis than the HCV-HCC group in stages I and II. Multivariate analysis revealed a significantly better RFS rate in the NBNC-HCC group.
The findings of this nationwide survey indicated that patients with NBNC-HCC had a significantly lower risk of HCC recurrence than those with HBV-HCC and HCV-HCC.
利用一项全国性调查的数据，比较乙型肝炎病毒（HBV）阳性、丙型肝炎病毒（HCV）阳性以及乙型肝炎表面抗原和丙型肝炎抗体阴性的患者（所谓的“非乙型肝炎/非丙型肝炎”）行肝切除术后的预后因素和结局。
在日本，“非乙型肝炎/非丙型肝炎”肝癌（HCC）的发病率正在迅速上升。
本研究共纳入 11950 例接受根治性肝切除术的 HBV-HCC（n=2194）、HCV-HCC（n=7018）或 NBNC-HCC（n=2738）患者。比较了各组的临床病理特征。对单因素分析确定的显著预后变量进行 Cox 比例风险回归模型的多因素分析。
HCV-HCC 组的肝功能明显差于 HBV-HCC 和 NBNC-HCC 组。NBNC-HCC 组的 HCC 分期明显比 HCV-HCC 组更晚。HBV-HCC、HCV-HCC 和 NBNC-HCC 组肝切除术后 5 年总生存率分别为 65%、59%和 68%。3 组 5 年无复发生存率（RFS）分别为 41%、31%和 47%。根据 TNM 分期分层 RFS 率显示，NBNC-HCC 组在 II、III 和 IVA 期的预后明显优于 HBV-HCC 组，在 I 和 II 期的预后明显优于 HCV-HCC 组。多因素分析显示，NBNC-HCC 组的 RFS 率明显更高。
这项全国性调查的结果表明，与 HBV-HCC 和 HCV-HCC 患者相比，NBNC-HCC 患者 HCC 复发的风险显著降低。
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