Zhong Jian-Hong, You Xue-Mei, Lu Shi-Dong, Wang Yan-Yan, Xiang Bang-De, Ma Liang, Wu Fei-Xiang, Yuan Wei-Ping, Chen Ying, Li Le-Qun
From the Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, P.R. China (J-HZ, X-MY, S-DL, Y-YW, B-DX, LM, F-XW, W-PY, L-QL); Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, PR China (J-HZ, X-MY, S-DL, Y-YW, B-DX, LM, F-XW, W-PY, L-QL); and Disease Classification Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, P.R. China (YC).
Medicine (Baltimore). 2015 Sep;94(35):e1426. doi: 10.1097/MD.0000000000001426.
The present study compared the efficacy of hepatic resection (HR) in patients with large hepatocellular carcinoma (HCC) and those with multinodular tumor and examined how that efficacy has changed over time in a large medical center.The intermediate stage of HCC comprises a highly heterogeneous patient population. Moreover, official guidelines have different views on the suitability of HR to treat such patients.A consecutive sample of 927 patients with preserved liver function and large and/or multinodular HCC who were treated by initial HR were divided into 3 groups: those with a single tumor ≥5 cm in diameter (n = 588), 2 to 3 tumors with a maximum diameter >3 cm (n = 225), or >3 tumors of any diameter (n = 114). Hospital mortality and overall survival (OS) in each group were compared for the years 2000 to 2007 and 2008 to 2013.Patients with >3 tumors showed the highest incidence of hospital mortality of all groups (P < 0.05). Kaplan-Meier survival analysis showed that OS varied across the 3 groups as follows: single tumor > 2 to 3 tumors > 3+ tumors (all P < 0.05). OS at 5 years ranged from 24% to 41% in all 3 groups for the period 2000 to 2007, and from 35% to 46% for the period 2008 to 2013. OS was significantly higher during the more recent 6-year period in the entire patient population, those with single tumor, and those with 3+ tumors (all P < 0.05). However, in patients with 2 to 3 tumors, OS was only slightly higher during the more recent 6-year period (P = 0.084).Prognosis can vary substantially for these 3 types of HCC. Patients with >3 tumors show the highest hospital mortality and lowest OS after HR. OS has been improving for all 3 types of HCC at our medical center as a consequence of improvements in surgical technique and perioperative management.
本研究比较了大肝细胞癌（HCC）患者与多结节肿瘤患者肝切除（HR）的疗效，并探讨了在一家大型医疗中心该疗效随时间的变化情况。HCC的中期患者群体高度异质。此外，官方指南对于HR治疗此类患者的适用性存在不同观点。将927例肝功能良好且患有大的和/或多结节HCC并接受初次HR治疗的患者连续样本分为3组：直径≥5 cm的单个肿瘤患者（n = 588）、最大直径>3 cm的2至3个肿瘤患者（n = 225）或任何直径的>3个肿瘤患者（n = 114）。比较了2000年至2007年以及2008年至2013年每组的医院死亡率和总生存期（OS）。肿瘤>3个的患者在所有组中医院死亡率最高（P < 0.05）。Kaplan-Meier生存分析显示，3组的OS情况如下：单个肿瘤>2至3个肿瘤>3个以上肿瘤（均P < 0.05）。在2000年至2007年期间，所有3组的5年OS率在24%至41%之间，2008年至2013年期间为35%至46%。在整个患者群体、单个肿瘤患者和3个以上肿瘤患者中，最近6年期间的OS明显更高（均P < 0.05）。然而对于2至3个肿瘤的患者，最近6年期间的OS仅略有升高（P = 0.084）。这3种类型的HCC预后可能有很大差异。肿瘤>3个的患者在HR后医院死亡率最高，OS最低。由于手术技术和围手术期管理的改善，在我们医疗中心这3种类型的HCC的OS都有所提高。
