El-Fattah Mohamed Abd
Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ring Road, Ismailia, Egypt.
Indian J Gastroenterol. 2017 Mar;36(2):117-125. doi: 10.1007/s12664-017-0732-x. Epub 2017 Feb 14.
The aim of this study is to evaluate the clinicopathologic prognostic factors of cancer-specific survival (CSS) in hepatocellular carcinoma (HCC) patients who underwent liver transplantation (LT) stratified by tumor size.
From the Surveillance, Epidemiology, and End Results (SEER) 18 registries (2004-2012), we retrieved data of 570 patients who underwent LT for a solitary primary HCC lesion ≤5 cm. A two multivariable Cox models were constructed to identify prognostic factors of CSS in a two different tumor sizes (2 cm cutoff).
Out of 570 HCC patients (median age 57 years), 16% had microvascular invasion (MVI) and 12% had a poorly differentiated tumor. Male sex (odds ratio [OR] 2.6), tumor size >2 cm (OR 1.78), elevated AFP (OR 2.31), and poor tumor differentiation (OR 2.59) are significant predictors of MVI. With a median follow up of 41.5 months (range 1-107 months), the 5-year CSS rate was 90% in the absence of MVI compared to 75% in the presence of MVI (p<0.001). Multivariate models revealed that age ≥60 years (hazard ratio [HR] 2.08), MVI (HR 2.26), and poor tumor differentiation (HR 2.42), were significant risk factors of a dismal CSS with HCC size >2 cm, but not with HCC ≤2 cm.
Primary HCC tumor size ≤2 cm had an excellent prognosis after LT and was not affect by the presence of MVI or poor tumor differentiation.
本研究旨在评估接受肝移植（LT）的肝细胞癌（HCC）患者按肿瘤大小分层后的癌症特异性生存（CSS）的临床病理预后因素。
从监测、流行病学和最终结果（SEER）18个登记处（2004 - 2012年），我们检索了570例因单发原发性HCC病灶≤5 cm接受LT的患者的数据。构建了两个多变量Cox模型，以确定两种不同肿瘤大小（以2 cm为界）下CSS的预后因素。
在570例HCC患者（中位年龄57岁）中，16%有微血管侵犯（MVI），12%有低分化肿瘤。男性（比值比[OR] 2.6）、肿瘤大小>2 cm（OR 1.78）、甲胎蛋白升高（OR 2.31）和肿瘤低分化（OR 2.59）是MVI的显著预测因素。中位随访41.5个月（范围1 - 107个月），无MVI时5年CSS率为90%，有MVI时为75%（p<0.001）。多变量模型显示，年龄≥60岁（风险比[HR] 2.08）、MVI（HR 2.26）和肿瘤低分化（HR 2.42）是HCC大小>2 cm时CSS不良的显著风险因素，但HCC≤2 cm时并非如此。
原发性HCC肿瘤大小≤2 cm在LT后预后良好，不受MVI或肿瘤低分化的影响。
