Kim Jun Young, Sinn Dong Hyun, Gwak Geum-Youn, Choi Gyu-Seong, Saleh Aldosri Meshal, Joh Jae-Won, Cho Sung Ki, Shin Sung Wook, Carriere Keumhee Chough, Ahn Joong Hyun, Paik Yong-Han, Choi Moon Seok, Lee Joon Hyeok, Koh Kwang Cheol, Paik Seung Woon
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Clin Mol Hepatol. 2016 Jun;22(2):250-8. doi: 10.3350/cmh.2016.0015. Epub 2016 Jun 30.
BACKGROUND/AIMS: Several studies have suggested that surgical resection (SR) can provide a survival benefit over transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) at the intermediate stage according to the Barcelona Clinic Liver Cancer (BCLC) staging system. However, the criteria for SR remain to be determined. This study compared the long-term outcome of intermediate-stage HCC patients treated by either TACE or SR as a primary treatment modality, with the aim of identifying the patient subgroup that gained a survival benefit by either modality.
In total, 277 BCLC intermediate-stage HCC patients treated by either TACE (N=225) or SR (N=52) were analyzed.
The overall median survival time was significantly better for SR than TACE (61 vs. 30 months, P=0.002). Decisiontree analysis divided patients into seven nodes based on tumor size and number, serum alpha-fetoprotein (AFP) level, and Child-Pugh score, and these were then simplified into four subgroups (B1-B4) based on similarities in the overall hazard rate. SR provided a significant survival benefit in subgroup B2, characterized by 'oligo' (2-4) nodules of intermediate size (5-10 cm) when the AFP levels was <400 ng/ml, or 'oligo' (2-4) nodules of small to intermediate size (<10 cm) plus a Child-Pugh score of 5 when the AFP level was ≥400 ng/mL (median survival 73 vs. 28 months for SR vs. TACE respectively; P=0.014). The survival rate did not differ significantly between SR and TACE in the other subgroups (B1 and B3).
SR provided a survival benefit over TACE in intermediate-stage HCC, especially for patients meeting certain criteria. Re-establishing the criteria for optimal treatment modalities in this stage of HCC is needed to improve survival rates.
背景/目的：多项研究表明，根据巴塞罗那临床肝癌（BCLC）分期系统，对于中期肝细胞癌（HCC）患者，手术切除（SR）比经动脉化疗栓塞术（TACE）能带来生存获益。然而，SR的标准仍有待确定。本研究比较了以TACE或SR作为主要治疗方式的中期HCC患者的长期预后，旨在确定通过这两种方式均可获得生存获益的患者亚组。
共分析了277例接受TACE（N = 225）或SR（N = 52）治疗的BCLC中期HCC患者。
SR组的总体中位生存时间显著优于TACE组（61个月对30个月，P = 0.002）。决策树分析根据肿瘤大小和数量、血清甲胎蛋白（AFP）水平及Child-Pugh评分将患者分为7个节点，然后根据总体风险率的相似性将其简化为4个亚组（B1 - B4）。SR在B2亚组中提供了显著的生存获益，该亚组特征为AFP水平<400 ng/ml时为中等大小（5 - 10 cm）的“寡”（2 - 4个）结节，或AFP水平≥400 ng/mL时为小至中等大小（<10 cm）的“寡”（2 - 4个）结节加Child-Pugh评分为5分（SR组与TACE组的中位生存时间分别为73个月对28个月；P = 0.014）。在其他亚组（B1和B3）中，SR和TACE的生存率无显著差异。
在中期HCC中，SR比TACE具有生存获益，尤其是对于符合特定标准的患者。需要重新确立HCC这一阶段的最佳治疗方式标准以提高生存率。
