Kow Alfred Wei Chieh, Kwon Choon Hyuck David, Song Sanghyun, Kim Jong Man, Joh Jae-Won
Department of HPB and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Surgery. 2015 Apr;157(4):645-53. doi: 10.1016/j.surg.2014.07.024. Epub 2014 Nov 4.
Recurrence after liver resection for hepatocellular carcinoma (HCC) is common. Resection of extrahepatic recurrences such as lung metastasectomy (LM) has been well documented. Conversely, reports on the long-term outcomes of peritoneal metastasectomy (PM) are lacking. In this study, we compared the outcome of lung and peritoneal metastasectomy after hepatectomies for HCC in a tertiary institution.
We reviewed retrospectively the data of 1,222 patients who underwent hepatectomies for HCC in Samsung Medical Center in Korea from January 2006 to August 2010. We studied the clinicopathologic factors between resected lung metastasis (LM) and peritoneal metastases (PM) and the long-term outcome of patient survival. Kaplan-Meier analysis was used to study the survival outcome.
The recurrence rate of resected HCC in this cohort was 41.6% (n = 508). Thirty-two patients with lung metastasis (23% of all lung metastasis) underwent LM whereas 13 patients (36% of all peritoneal metastasis) with peritoneal metastasis underwent PM. Two patients underwent PM and LM sequentially. Demographic and clinical data between the LM and PM groups were comparable. The mean prehepatectomy PIVKA-II level was greater in the LM group compared with the PM group (P = .029). On univariate analysis of pathologic factors, the median tumor size (P = .005), proportion of patients with tumor >75 mm (P = .005) and rate of microvascular invasion (P = .047) were greater in the LM group. The median time-to-recurrence in the LM group was 12 (4-45) months compared with 18 (1-102) months in the PM group (P = .896). The 1-year, 3-year, and 5-year overall survival of patients in the LM group was 92%, 55%, 55% (4-year) whereas that in the PM group was 90%, 75%, and 75%, respectively. The mean overall survival in the LM was comparable with that in the PM group (P = .578).
Twenty-three percent of patients with lung metastasis and 36.1% of patients with peritoneal metastasis could be considered for metastasectomy. The long-term survival of patients with PM and LM was comparable in this study. Although resection of LM improves survival in patients with resected HCC, we demonstrated favorable outcomes for PM as well, which in the past would have been considered palliative.
肝细胞癌（HCC）肝切除术后复发很常见。肝外复发灶的切除，如肺转移瘤切除术（LM）已有充分记录。相反，关于腹膜转移瘤切除术（PM）的长期疗效报告较少。在本研究中，我们比较了在一家三级医疗机构中，HCC肝切除术后肺和腹膜转移瘤切除术的疗效。
我们回顾性分析了2006年1月至2010年8月在韩国三星医疗中心接受HCC肝切除术的1222例患者的数据。我们研究了切除的肺转移（LM）和腹膜转移（PM）之间的临床病理因素以及患者生存的长期疗效。采用Kaplan-Meier分析来研究生存结果。
该队列中切除的HCC复发率为41.6%（n = 508）。32例肺转移患者（占所有肺转移患者的23%）接受了LM，而13例腹膜转移患者（占所有腹膜转移患者的36%）接受了PM。2例患者先后接受了PM和LM。LM组和PM组之间的人口统计学和临床数据具有可比性。LM组肝切除术前PIVKA-II水平的平均值高于PM组（P = 0.029）。在病理因素的单因素分析中，LM组的肿瘤中位大小（P = 0.005）、肿瘤>75 mm患者的比例（P = 0.005）和微血管侵犯率（P = 0.047）更高。LM组的中位复发时间为12（4 - 45）个月，而PM组为18（1 - 102）个月（P = 0.896）。LM组患者的1年、3年和5年总生存率分别为92%、55%、55%（4年），而PM组分别为90%、75%和75%。LM组的平均总生存率与PM组相当（P = 0.578）。
23%的肺转移患者和36.1%的腹膜转移患者可考虑进行转移瘤切除术。本研究中PM和LM患者的长期生存率相当。虽然LM切除可提高切除的HCC患者的生存率，但我们也证明了PM的良好疗效，而在过去PM被认为是姑息性的。
