Lim Chetana, Salloum Chady, Osseis Michael, Lahat Eylon, Gómez-Gavara Concepción, Compagnon Philippe, Luciani Alain, Feray Cyrille, Azoulay Daniel
AP-HP Henri Mondor Hospital, Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Créteil, France; University Paris 12, UPEC, Créteil, France.
AP-HP Henri Mondor Hospital, Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Créteil, France.
HPB (Oxford). 2018 Mar;20(3):222-230. doi: 10.1016/j.hpb.2017.08.027. Epub 2017 Sep 19.
Western guidelines recommend resection for hepatocellular carcinoma (HCC) in so-called ideal cirrhotic patients with a Barcelona Clinic Liver Cancer (BCLC) stage 0-A tumour. This study compares short-term outcomes following resection between patients defined as ideal and nonideal according to the BCLC guidelines.
This prospective single-centre open study (ClinicalTrials.govNCT02145013) included all cirrhotic patients with HCC referred for resection from 2014 to 2016. Mortality, morbidity, unresolved liver decompensation, and readmission were measured.
The study population included 65 consecutive patients: 32 (49%) ideal and 33 (51%) nonideal. Ideal and nonideal groups did not differ in mortality (3% vs. 6%; p = 0.57), morbidity (53% vs. 73%; p = 0.10), or unresolved liver decompensation (6% vs. 15%; p = 0.23) at 90 days. The readmission rate was higher in the nonideal (21%) than in the ideal group (3%; p = 0.02).
Straying from the current guidelines for resection in a selected subset of nonideal patients doubled the number of resections performed for treating HCC, with satisfactory short-term outcomes. These results argue for the expansion of the acknowledged BCLC guidelines.
西方指南推荐，对于巴塞罗那临床肝癌（BCLC）分期为0 - A期肿瘤的所谓理想肝硬化患者，应进行肝细胞癌（HCC）切除术。本研究比较了根据BCLC指南定义为理想和非理想的患者在切除术后的短期结局。
这项前瞻性单中心开放性研究（ClinicalTrials.govNCT02145013）纳入了2014年至2016年所有因HCC转诊接受切除术的肝硬化患者。测量了死亡率、发病率、未解决的肝失代偿情况和再入院率。
研究人群包括65例连续患者：32例（49%）为理想患者，33例（51%）为非理想患者。理想组和非理想组在90天时的死亡率（3%对6%；p = 0.57）、发病率（53%对73%；p = 0.10）或未解决的肝失代偿情况（6%对15%；p = 0.23）方面无差异。非理想组的再入院率（21%）高于理想组（3%；p = 0.02）。
在选定的非理想患者亚组中偏离当前的切除指南，使治疗HCC的切除例数增加了一倍，短期结局令人满意。这些结果支持扩大公认的BCLC指南。
