Scatton Olivier, Goumard Claire, Cauchy Francois, Fartoux Laetitia, Perdigao Fabiano, Conti Filomena, Calmus Yvon, Boelle Pierre Yves, Belghiti Jacques, Rosmorduc Olivier, Soubrane Olivier
Departments of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France.
Université Pierre et Marie Curie, Paris 6.
J Surg Oncol. 2015 Jun;111(8):1007-15. doi: 10.1002/jso.23916. Epub 2015 Apr 28.
Liver transplantation (LT) remains the best curative option for early hepatocellular carcinoma (HCC) but is limited by the ongoing graft shortage. The present study aimed at defining the population in which primary liver resection (LR) could represent the best alternative to LT.
An exploration set of 357 HCC patients (LR n = 221 and LT n = 136) operated between 2000-2012 was used in order to identify factors associated with survival following LR and define a good prognosis (GP) group for which LR may challenge the results of upfront LT. These factors were validated in an external validation set of 565 HCC patients operated at another center (LR n = 287 LR and LT n = 278).
In the exploration set, factors associated with survival on multivariate analysis were a solitary lesion, a diameter <50 mm, a well-moderately differentiated lesion, the absence of microvascular invasion, and preoperative AST level <2N. Thirty-nine patients (18%) displayed all these criteria and constituted the GP patients. Overall survivals at 1, 3, and 5 years did not significantly differ between GP resected patients, and the in Milan transplanted patients (93, 80.4, and 80.4% vs. 86.9, 82, and 78.8%, P = 0.79). In the validation cohort, patients with GP factors of survival still displayed better overall survivals than those without (P = 0.036) but also displayed better survivals than in Milan HCC transplanted patients (P = 0.005).
In a group of early HCC patients gathering all factors of GP, primary LR achieves at least similar survival as upfront LT and should be the approach of choice.
肝移植（LT）仍然是早期肝细胞癌（HCC）的最佳治愈选择，但受到供肝持续短缺的限制。本研究旨在确定原发性肝切除（LR）可作为LT最佳替代方案的人群。
使用一组于2000年至2012年间接受手术的357例HCC患者（LR组n = 221，LT组n = 136），以确定与LR术后生存相关的因素，并定义一个LR可能挑战直接LT结果的良好预后（GP）组。这些因素在另一个中心接受手术的565例HCC患者（LR组n = 287，LT组n = 278）的外部验证组中得到验证。
在探索组中，多因素分析显示与生存相关的因素包括单个病灶、直径<50 mm、中高分化病灶、无微血管侵犯以及术前AST水平<2倍正常值上限。39例患者（18%）符合所有这些标准，构成了GP患者。GP组接受肝切除患者与米兰标准内接受肝移植患者的1年、3年和5年总生存率无显著差异（分别为93%、80.4%、80.4% 与86.9%、82%、78.8%，P = 0.79）。在验证队列中，具有生存GP因素的患者总体生存率仍高于无该因素的患者（P = 0.036），并且也高于米兰标准内HCC肝移植患者（P = 0.005）。
在一组具备所有GP因素的早期HCC患者中，原发性LR至少能获得与直接LT相似的生存率，应作为首选方法。
