早期肝细胞癌作为后续恶性肿瘤的信号性病变。

Early hepatocellular carcinoma as a signaling lesion for subsequent malignancy.

作者信息

Midorikawa Yutaka, Takayama Tadatoshi, Higaki Tokio, Nakayama Hisashi, Yamamoto Masakazu, Ariizumi Shunichi, Shimada Kazuaki, Kokudo Norihiro, Tsuji Shingo, Tsuchiya Kaoru, Kurosaki Masayuki, Izumi Namiki

机构信息

Department of Digestive Surgery, Nihon University School of Medicine, Tokyo.

Department of Digestive Surgery, Nihon University School of Medicine, Tokyo

出版信息

Jpn J Clin Oncol. 2016 Dec;46(12):1102-1107. doi: 10.1093/jjco/hyw133. Epub 2016 Sep 12.

DOI:10.1093/jjco/hyw133

PMID:27620728

Abstract

OBJECTIVE

Early diagnosis and treatment of cancer may contribute substantially to complete cure, but it remains unknown whether treatment of early hepatocellular carcinoma can actually result in cure. This study was performed to clarify the cancer risk of the background liver after treating early hepatocellular carcinoma.

METHODS

Early hepatocellular carcinoma is defined as very well-differentiated cancer containing Glisson's triad. The cumulative incidence of classical hepatocellular carcinoma, hypervascular liver cancer detected on imaging studies, after resection of early hepatocellular carcinoma positive for anti-hepatitis C antibody (early hepatocellular carcinoma group, n = 105) was compared with that in patients with chronic liver disease positive for anti-hepatitis C antibody (control group, n = 751) and propensity score-matched patients after resection of classical hepatocellular carcinoma (classical hepatocellular carcinoma group, n = 105).

RESULTS

After a median follow-up of 4.8 years (range, 0.3-15.0), the cumulative incidence of classical hepatocellular carcinoma at 5 years was 56.9% (95% confidence interval, 44.2-67.7%) in the early hepatocellular carcinoma group and 70.6% (52.5-81.8%) in the classical hepatocellular carcinoma group as compared with 4.6% (2.8-6.4%) in the control group. The risk of the development of classical hepatocellular carcinoma in the early hepatocellular carcinoma group was significantly higher than that in the control group (hazard ratio, 17.5; 95% confidence interval, 12.1-25.3; P < 0.001) and significantly lower than that in the classical hepatocellular carcinoma group (hazard ratio, 0.60; 0.41-0.89; P = 0.010). However, the cumulative incidence of second primary hepatocellular carcinoma in patients with one early hepatocellular carcinoma did not differ significantly from that in patients with two or more early hepatocellular carcinoma lesions (hazard ratio, 1.50; 0.85-2.65; P = 0.157).

CONCLUSIONS

Treatment of early hepatocellular carcinoma cannot provide complete cure due to the substantial risk of developing classical hepatocellular carcinoma.

摘要

目的

癌症的早期诊断和治疗对实现完全治愈可能有很大帮助，但早期肝细胞癌的治疗是否真能治愈仍不清楚。本研究旨在明确早期肝细胞癌治疗后肝脏背景的癌症风险。

方法

早期肝细胞癌定义为包含肝门三联的高分化癌。比较抗丙型肝炎抗体阳性的早期肝细胞癌切除术后（早期肝细胞癌组，n = 105）经典肝细胞癌、影像学检查发现的富血管肝癌的累积发病率，与抗丙型肝炎抗体阳性的慢性肝病患者（对照组，n = 751）以及经典肝细胞癌切除术后倾向评分匹配的患者（经典肝细胞癌组，n = 105）的发病率。

结果

中位随访4.8年（范围0.3 - 15.0年）后，早期肝细胞癌组5年时经典肝细胞癌的累积发病率为56.9%（95%置信区间，44.2 - 67.7%），经典肝细胞癌组为70.6%（52.5 - 81.8%），而对照组为4.6%（2.8 - 6.4%）。早期肝细胞癌组发生经典肝细胞癌的风险显著高于对照组（风险比，17.5；95%置信区间，12.1 - 25.3；P < 0.001），且显著低于经典肝细胞癌组（风险比，0.60；0.41 - 0.89；P = 0.010）。然而，有一个早期肝细胞癌病灶的患者发生第二原发性肝细胞癌的累积发病率与有两个或更多早期肝细胞癌病灶的患者相比无显著差异（风险比，1.50；0.85 - 2.65；P = 0.157）。