Kuo Tse-Ming, Chang Kai-Ming, Cheng Tsun-I, Kao Kuo-Jang
Division of Gastroenterology and Hepatobiliary Disease, Department of Medicine, Taipei, Taiwan, ROC.
Department of Research, Koo Foundation Sun-Yat Sen Cancer Center, Taipei, Taiwan, ROC.
Liver Cancer. 2017 Nov;6(4):297-306. doi: 10.1159/000477134. Epub 2017 Aug 29.
In patients with lung metastasis of hepatocellular carcinoma (HCC), it remains uncertain how a better survival outcome can be predicted after metastasectomy. This study aims to identify clinical factors that may be used to guide patient selection for such a therapeutic modality. A total of 28 patients who received pulmonary metastasectomy for HCC between 1993 and 2012 were identified. All relevant clinical factors were extracted from medical records up to September 2015. Patients were classified into high- and low-risk groups according to survival outcome after metastasectomy. All pertinent clinical factors were analyzed for correlation with survival outcome.
The overall survival of 28 patients after pulmonary metastasectomy was studied first. The survival curve was biphasic and reached a plateau at 40 months after metastasectomy. The results indicate the presence of 2 groups of patients with a different survival outcome. Among all clinical parameters, remission status in the liver before pulmonary metastasectomy and distant metastasis-free interval between the last treatment of HCC and the occurrence of lung metastasis were found to be significantly associated with excellent survival outcome after pulmonary metastasectomy ( = 0.019 and 0.007 by Fisher exact test, and = 0.002 and 0.0002 by Cox regression analysis).
在肝细胞癌（HCC）肺转移患者中，对于转移灶切除术后如何预测更好的生存结局仍不明确。本研究旨在确定可用于指导选择这种治疗方式的患者的临床因素。共确定了1993年至2012年间接受HCC肺转移灶切除术的28例患者。截至2015年9月，从病历中提取了所有相关临床因素。根据转移灶切除术后的生存结局，将患者分为高风险组和低风险组。分析了所有相关临床因素与生存结局的相关性。
首先研究了28例患者肺转移灶切除术后的总生存期。生存曲线呈双相性，在转移灶切除术后40个月达到平台期。结果表明存在两组生存结局不同的患者。在所有临床参数中，肺转移灶切除术前肝脏的缓解状态以及HCC最后一次治疗与肺转移发生之间的无远处转移间期，被发现与肺转移灶切除术后的良好生存结局显著相关（Fisher精确检验P值分别为0.019和0.007，Cox回归分析P值分别为0.002和0.0002）。
