Chapman William C, Klintmalm Goran, Hemming Alan, Vachharajani Neeta, Majella Doyle Maria B, DeMatteo Ron, Zaydfudim Victor, Chung Haniee, Cavaness Keith, Goldstein Robert, Zendajas Ivan, Melstrom Laleh G, Nagorney David, Jarnagin William
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
Department of Surgery, Baylor University, Waco, TX.
J Am Coll Surg. 2015 Apr;220(4):628-37. doi: 10.1016/j.jamcollsurg.2014.12.030. Epub 2015 Jan 6.
The incidence of hepatocellular cancer (HCC) is increasing dramatically worldwide. Optimal management remains undefined, especially for well-compensated cirrhosis and HCC.
This retrospective analysis included 5 US liver cancer centers. Patients with surgically treated HCC between 1990 and 2011 were analyzed; demographics, tumor characteristics, and survival rates were included.
There were 1,765 patients who underwent resection (n = 884, 50.1%) or transplantation (n = 881, 49.9%). Overall, 248 (28.1%) resected patients were transplant eligible (1 tumor <5 cm or 2 to 3 tumors all <3 cm, no major vascular invasion); these were compared with 496 transplant patients, matched based on year of transplantation and tumor status. Overall survivals at 5 and 10 years were significantly improved for transplantation patients (74.3% vs 52.8% and 53.7% vs 21.7% respectively, p < 0.001), with greater differences in disease-free survival (71.8% vs 30.1% at 5 years and 53.4% vs 11.7% at 10 years, p < 0.001). Ninety-seven of the 884 (11%) resected patients were within Milan criteria and had cirrhosis; these were compared with the 496 transplantation patients, with similar results to the overall group. On multivariate analysis, type of surgery was an independent variable affecting all survival outcomes.
The increasing incidence of HCC stresses limited resources. Although transplantation results in better long-term survival, limited donor availability precludes widespread application. Hepatic resection will likely remain a standard therapy in selected patients with HCC. In this large series, only about 10% of patients with cirrhosis were transplant-eligible based on tumor status. Although liver transplantation results are significantly improved compared with resection, transplantation is available only for a minority of patients with HCC.
全球肝细胞癌（HCC）的发病率正在急剧上升。最佳治疗方案仍不明确，尤其是对于代偿良好的肝硬化和HCC患者。
这项回顾性分析纳入了美国5家肝癌中心。对1990年至2011年间接受手术治疗的HCC患者进行分析，包括人口统计学、肿瘤特征和生存率。
共有1765例患者接受了肝切除术（n = 884，50.1%）或肝移植术（n = 881，49.9%）。总体而言，248例（28.1%）接受肝切除的患者符合肝移植标准（单个肿瘤<5 cm或2至3个肿瘤均<3 cm，无大血管侵犯）；将这些患者与496例肝移植患者进行比较，根据移植年份和肿瘤状态进行匹配。肝移植患者的5年和10年总生存率显著提高（分别为74.3%对52.8%和53.7%对21.7%，p < 0.001），无病生存率差异更大（5年时为71.8%对30.1%，10年时为53.4%对11.7%，p < 0.001）。884例接受肝切除的患者中有97例（11%）符合米兰标准且患有肝硬化；将这些患者与496例肝移植患者进行比较，结果与总体组相似。多因素分析显示，手术方式是影响所有生存结局的独立变量。
HCC发病率的上升凸显了资源的有限性。尽管肝移植可带来更好的长期生存，但供体可用性有限阻碍了其广泛应用。肝切除术可能仍将是部分HCC患者的标准治疗方法。在这个大型队列中，根据肿瘤状态，只有约10%的肝硬化患者符合肝移植标准。尽管与肝切除术相比，肝移植的结果有显著改善，但肝移植仅适用于少数HCC患者。
