Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland2Hepatobiliary Surgery Division, Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan3Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
Hepatobiliary Surgery Division, Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan3Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
JAMA Surg. 2017 Mar 15;152(3):e165059. doi: 10.1001/jamasurg.2016.5059.
Background hepatocarcinogenesis is considered a major cause of postoperative recurrence of de novo hepatocellular carcinoma (HCC) in patients with liver cirrhosis (LC). The degree of underlying liver injury has reportedly correlated with surgical outcomes of HCC. However, the pattern and annual rate of recurrence of postoperative de novo HCC are still unclear.
To clarify the pattern and rate of recurrence of de novo HCC in patients with LC.
DESIGN, SETTING, AND PARTICIPANTS: Data from 799 patients who underwent curative hepatectomy for HCC at Toranomon Hospital and The Johns Hopkins Hospital between January 1, 1995, and December 31, 2014, were retrospectively collected and analyzed. Of the patients who underwent curative hepatectomy for HCC, 424 met inclusion criteria: 73 with normal liver (NL) and 351 with LC. Sixty-four patients who had histologically proven NL parenchyma were matched with an equal number of patients who had established LC, and postoperative outcomes were compared.
Hepatectomy in patients with HCC.
Patterns of recurrence of HCC and chronological changes in recurrence rates.
Among 128 matched patients in the study (mean [SD] age, 64.0 [12.7] years; 93 men and 35 women) 1-, 3-, and 5-year cumulative recurrence was 17.2%, 23.0%, and 37.5%, respectively, in the NL group vs 25.0%, 55.5%, and 72.1%, respectively, in the LC group (P = .001). The 3- and 5-year disease-specific survival was 85.7% and 75.4%, respectively, in the NL group vs 74.9% and 59.1%, respectively, in the LC group (P = .04). The median annual incidence of postoperative recurrence of HCC within 5 years after surgery was lower in the NL group (5.9%) compared with the LC group (12.7%) (P = .003). Assessment of recurrence patterns revealed that multiple recurrences near the resection margin or at extrahepatic sites were more frequent in the NL group (9 [50.0%] vs 6 [15.4%]; P = .01), whereas solitary recurrence at a distant site was more common in the LC group (21 [53.8%] vs 1 [5.6%]; P < .001).
Comparison of the patterns and annual incidence of recurrence of HCC demonstrated that the poorer prognosis in the LC group was likely owing to a higher hepatocarcinogenic potential among patients with cirrhosis. Annual recurrence rates in the 2 groups indicate that de novo recurrence may continuously occur from the early postoperative period until the late period after resection of HCC.
背景性肝肿瘤发生被认为是肝硬化（LC）患者新发生肝细胞癌（HCC）术后复发的主要原因。据报道，肝损伤程度与 HCC 的手术结果相关。然而，术后新发生 HCC 的复发模式和年复发率仍不清楚。
阐明 LC 患者新发生 HCC 的复发模式和复发率。
设计、地点和参与者：回顾性收集并分析了 1995 年 1 月 1 日至 2014 年 12 月 31 日期间在 Toranomon 医院和约翰霍普金斯医院接受根治性肝切除术治疗 HCC 的 799 例患者的数据。在接受 HCC 根治性肝切除术的患者中，有 424 例符合纳入标准：73 例为正常肝（NL），351 例为 LC。有 64 例患者的肝组织学证实为 NL 实质，与相等数量的已确诊 LC 患者相匹配，并比较了术后结果。
HCC 患者的肝切除术。
HCC 复发的模式和复发率的时间变化。
在这项研究中的 128 对匹配患者（平均[标准差]年龄，64.0[12.7]岁；93 名男性和 35 名女性）中，NL 组的 1、3 和 5 年累积复发率分别为 17.2%、23.0%和 37.5%，LC 组分别为 25.0%、55.5%和 72.1%（P = .001）。NL 组的 3 年和 5 年疾病特异性生存率分别为 85.7%和 75.4%，LC 组分别为 74.9%和 59.1%（P = .04）。NL 组术后 5 年内 HCC 术后复发的中位年发生率（5.9%）低于 LC 组（12.7%）（P = .003）。复发模式评估显示，NL 组更频繁地出现切除边缘或肝外部位的多处复发（9 [50.0%] vs 6 [15.4%]；P = .01），而 LC 组更常见远处部位的单发复发（21 [53.8%] vs 1 [5.6%]；P < .001）。
对 HCC 复发模式和年复发率的比较表明，LC 组预后较差可能是由于肝硬化患者的肝癌发生潜力更高。两组的年复发率表明，新发生的 HCC 可能会从 HCC 切除后的早期持续复发到晚期。
