Suh Suk Won, Choi Yoo Shin
Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea.
Yonsei Med J. 2017 Jul;58(4):737-742. doi: 10.3349/ymj.2017.58.4.737.
Transarterial chemoembolization (TACE) is indicated for Barcelona Clinic Liver Cancer (BCLC) B hepatocellular carcinoma (HCC). Whether TACE provides any long-term survival benefits remains unclear. We aimed to investigate micrometastases predictors with which to identify patients who would benefit from surgical resection (SR).
First, we analyzed risk factors of micrometastases, microvascular invasion, and poor histologic grade in 38 patients with newly diagnosed resectable BCLC stage B HCC limited to one or two segments with well-preserved liver function and who underwent SR between January 2006 and December 2013. Second, we validated identified risk factors in 54 newly diagnosed resectable BCLC B HCC patients with well-preserved liver function who underwent TACE during the same period to determine their influence on survival.
Risk factors of micrometastases in SR patients were α-fetoprotein (AFP) ≥110 [hazard ratio (HR)=5.166; 95% confidence interval (CI), 1.031-25.897; p=0.046] and prothrombin induced by vitamin K absence-II (PIVKA-II) ≥800 (HR=5.166; 95% CI, 1.031-25.897; p=0.046). The cumulative probability of tumor recurrence (p=0.009) after SR differed according to levels of AFP and PIVKA-II. After validation of these risk factors in the TACE group, patients with SR and AFP <110 and PIVKA-II <800 had superior survival outcomes than other patients (HR=0.116; 95% CI, 0.027-0.497; p=0.004).
AFP and PIVKA-II levels predict micrometastases and survival. Therefore, they should be considered when selecting SR for BCLC B HCC.
经动脉化疗栓塞术（TACE）适用于巴塞罗那临床肝癌（BCLC）B期肝细胞癌（HCC）。TACE是否能带来任何长期生存益处仍不清楚。我们旨在研究微转移预测指标，以识别能从手术切除（SR）中获益的患者。
首先，我们分析了2006年1月至2013年12月期间38例新诊断的可切除BCLC B期HCC患者的微转移、微血管侵犯及组织学分级差的危险因素，这些患者肝功能良好，肿瘤局限于一或两个肝段且接受了SR。其次，我们在同期接受TACE的54例新诊断的肝功能良好的可切除BCLC B期HCC患者中验证了所确定的危险因素，以确定它们对生存的影响。
SR患者微转移的危险因素为甲胎蛋白（AFP）≥110[风险比（HR）=5.166；95%置信区间（CI），1.031 - 25.897；p = 0.046]和维生素K缺乏诱导蛋白II（PIVKA-II）≥800（HR = 5.166；9�%CI，1.031 - 25.897；p = 0.046）。SR术后肿瘤复发的累积概率（p = 0.009）因AFP和PIVKA-II水平而异。在TACE组验证这些危险因素后，SR且AFP < 110及PIVKA-II < 800的患者生存结局优于其他患者（HR = 0.116；95%CI，0.027 - 0.497；p = 0.004）。
AFP和PIVKA-II水平可预测微转移和生存。因此，为BCLC B期HCC选择SR时应考虑这些指标。
