Ciria R, López-Cillero P, Gallardo A-B, Cabrera J, Pleguezuelo M, Ayllón M-D, Luque A, Zurera L, Espejo J-J, Rodríguez-Perálvarez M, Montero J-L, de la Mata M, Briceño J
Unit of Hepatobiliary Surgery and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Cordoba, Spain.
Unit of Hepatobiliary Surgery and Liver Transplantation, CIBERehd, IMIBIC, University Hospital Reina Sofía, Cordoba, Spain.
Eur J Surg Oncol. 2015 Sep;41(9):1153-61. doi: 10.1016/j.ejso.2015.05.023. Epub 2015 Jun 12.
To analyse the impact of liver resection (LR) in patients with Hepatocellular Carcinoma (HCC) within the Barcelona-Clinic-Liver-Cancer (BCLC)-B stage.
Analysis of patients with BCLC-B HCC treated with LR or transarterial chemoembolization (TACE) between 2007 and 2012 in our hospital. Survival/recurrence analyses were performed by log-rank tests and Cox multivariate models. Further analyses were specifically obtained for the HCC subclassification (B1-2-3-4) proposed recently.
Eighty patients were treated (44-TACE/36-LR). Number of nodules was [1.8(1.1)], being multinodular in 50% of cases. Although resected patients had a higher hospital stay than those who underwent TACE (14 ± 13 vs 7 ± 6; P = 0.004), the rate and severity of complications was lower measured by Dindo-Clavien scale (P < 0.05). Overall survival was 40% with a median follow-up of 29.5 months (0.07-96.9). Five-years survival rates were 62.9%, 28.1% and 15.4%, respectively (P = 0.004) for B1, B2 and B3-4 stages. Cox model showed that only total bilirubin [OR = 2.055(1.23-3.44)] and BCLC subclassification B3-4 [OR = 2.439(1.04-5.7)] and B2 [OR = 2.79(1.35-5.77)] vs B1 were independent predictors of 5-years-survival. In B1 patients, surgical approach led a significant decrease in 5-years recurrence-rate (25% vs 60%; P = 0.018). In the surgical subgroup analysis, better results were observed if well/moderate differentiation combined with no microvascular-invasion (VI) in 5-years-survival (84.6%; P = 0.001) and -recurrence (23.1%; P = 0.041), respectively. These survival and recurrence trends were remarkable in B1 stages.
Management of Intermediate BCLC-B HCC stage should be more complex and include updated criteria regarding B-stage subclassifications, VI and tumour differentiation. Modern surgical resection would offer improved survival benefit with acceptable safety in selected BCLC-B stage patients.
分析巴塞罗那临床肝癌（BCLC）-B期肝细胞癌（HCC）患者行肝切除（LR）的影响。
分析2007年至2012年在我院接受LR或经动脉化疗栓塞术（TACE）治疗的BCLC-B期HCC患者。通过对数秩检验和Cox多变量模型进行生存/复发分析。针对最近提出的HCC亚分类（B1-2-3-4）进行了进一步分析。
共治疗80例患者（44例行TACE/36例行LR）。结节数量为[1.8(1.1)]，50%的病例为多结节。虽然接受肝切除的患者住院时间比接受TACE的患者长（14±13天 vs 7±6天；P = 0.004），但根据Dindo-Clavien量表测量，并发症的发生率和严重程度较低（P < 0.05）。总生存率为40%，中位随访时间为29.5个月（0.07 - 96.9个月）。B1、B2和B3-4期的5年生存率分别为62.9%、28.1%和15.4%（P = 0.004）。Cox模型显示，只有总胆红素[比值比（OR）= 2.055(1.23 - 3.44)]以及BCLC亚分类B3-4[OR = 2.439(1.04 - 5.7)]和B2[OR = 2.79(1.35 - 5.77)]与B1相比是5年生存率的独立预测因素。在B1期患者中，手术治疗使5年复发率显著降低（25% vs 60%；P = 0.018）。在手术亚组分析中，5年生存率（84.6%；P = 0.001）和复发率（23.1%；P = 0.041）在高/中分化且无微血管侵犯（VI）的情况下结果更好。这些生存和复发趋势在B1期尤为显著。
BCLC-B期中期HCC的管理应更加复杂，包括关于B期亚分类、VI和肿瘤分化的更新标准。现代手术切除对于特定的BCLC-B期患者可提供更好的生存获益且安全性可接受。
