Bell Richard, Pandanaboyana Sanjay, Lodge J Peter A, Prasad K Raj, Jones Rebecca, Hidalgo Ernest
Department of HPB and Transplant Surgery, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, England, UK.
Department of HPB and Transplant Surgery, Faculty of Medical and Health Sciences at the University of Auckland, Auckland City Hospital, Auckland, New Zealand.
Langenbecks Arch Surg. 2017 Jun;402(4):575-583. doi: 10.1007/s00423-016-1475-3. Epub 2016 Jul 25.
This study aims to report the outcomes following primary liver resection (PLR) in patients with cirrhosis including stratification according to the Barcelona Clinic Liver Cancer (BCLC) classification.
Patients with cirrhosis and hepatocellular carcinoma (HCC) who had PLR between 2000 and 2013 were examined. Overall survival (OS), disease-free survival (DFS) and recurrence rate (RR) were analysed. Management after recurrence was reviewed as well as comparison to a series of 116 patients listed directly for liver transplant.
Seventy-one patients underwent PLR. Median follow-up was 40 months. The 1-, 3- and 5-year OS and DFS for the series were 77, 69 and 61 % and 69, 39 and 28 % respectively. Overall recurrence was 59 % (44/71) and only 36 % (15/44) of those patients had a further potentially curative procedure. The 1-3-5-year OS and DFS in the BCLC-A (44 patients) were 86, 78 and 68 % and 78, 48 and 44 % respectively. The RR in BCLC-A was 45 % (20 patients) with half (11 patients) suitable for further treatment with curative intent. The 1-3-5-year OS and DFS in the BCLC-B (17 patients) were 81, 74 and 60 % and 58, 29 and 7 % respectively. The overall RR in BCLC-B was 76 % (13 patients).
Recurrence following PLR for HCC in patients with cirrhosis is high with only a third of patients suitable for further potentially curative procedures. For patients with BCLC-A (or within Milan criteria), PLR provided a 68 % 5-year OS with 44 % of them free of disease. Surgery can offer satisfactory OS in carefully selected patients in the BCLC-B stage.
本研究旨在报告肝硬化患者接受原发性肝切除（PLR）后的结果，包括根据巴塞罗那临床肝癌（BCLC）分类进行分层。
对2000年至2013年间接受PLR的肝硬化和肝细胞癌（HCC）患者进行检查。分析总生存期（OS）、无病生存期（DFS）和复发率（RR）。对复发后的治疗进行回顾，并与一系列直接列入肝移植名单的116例患者进行比较。
71例患者接受了PLR。中位随访时间为40个月。该系列患者的1年、3年和5年总生存率和无病生存率分别为77%、69%和61%以及69%、39%和28%。总体复发率为59%（44/71），其中只有36%（15/44）的患者接受了进一步的潜在根治性手术。BCLC-A期（44例患者）的1年、3年和5年总生存率和无病生存率分别为86%、78%和68%以及78%、48%和44%。BCLC-A期的复发率为45%（20例患者），其中一半（11例患者）适合进一步进行根治性治疗。BCLC-B期（17例患者）的1年、3年和5年总生存率和无病生存率分别为81%、74%和60%以及58%、29%和7%。BCLC-B期的总体复发率为76%（13例患者）。
肝硬化患者肝癌接受PLR后的复发率很高，只有三分之一的患者适合进一步进行潜在根治性手术。对于BCLC-A期（或符合米兰标准）的患者，PLR提供了68%的5年总生存率，其中44%的患者无疾病。对于精心挑选的BCLC-B期患者，手术可以提供令人满意的总生存率。
