Guo Hui, Wu Tao, Lu Qiang, Li Miaojing, Guo Jing-Yue, Shen Yuan, Wu Zheng, Nan Ke-Jun, Lv Yi, Zhang Xu-Feng
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Department of Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Cancer Manag Res. 2018 Feb 21;10:361-369. doi: 10.2147/CMAR.S152707. eCollection 2018.
Surgical resection remains a controversial treatment for hepatocellular carcinoma (HCC) within different Barcelona Clinic Liver Cancer (BCLC) stages. The objective of this study was to evaluate the long-term outcome of patients undergoing surgical resection (SR) compared to non-surgical treatments across different BCLC stages.
One thousand four hundred forty-three HCC patients within BCLC 0, A, B and C stages were identified. Overall survival was compared by log-rank test among patients within different BCLC stages and among patients receiving different treatments (SR vs locoregional therapy [LRT] vs best supportive care). Propensity score matching analysis was introduced to mitigate the confounding biases between the groups.
The median survival time of the patients diminished from early, intermediate to advanced BCLC stages (BCLC 0-A 43 [range 0-100] months vs BCLC B 32 [range 0-100] months vs BCLC C 27 [range 0-90] months, all <0.05). Patients undergoing SR presented with better liver function and more favorable tumor status and, consequently, displayed significant better overall survival than patients receiving LRT or best supportive care at different BCLC stages. In adjusted cohort after propensity score matching, patients who were surgically treated consistently had more favorable outcome than those who were non-curatively treated across different BCLC stages (median survival [range]: BCLC stage B: resection 45 [0-100] months vs LRT 36 [0-81] months, =0.002; BCLC stage C: resection 39 [3-77] months vs LRT 27 [0-54] months, =0.003).
Surgical resection should be considered as a radical treatment for selected HCC patients regardless of the BCLC stages when appropriate.
对于不同巴塞罗那临床肝癌（BCLC）分期的肝细胞癌（HCC）患者，手术切除仍是一种存在争议的治疗方法。本研究的目的是评估不同BCLC分期下接受手术切除（SR）的患者与非手术治疗患者的长期预后。
确定了1443例处于BCLC 0、A、B和C期的HCC患者。通过对数秩检验比较不同BCLC分期患者以及接受不同治疗（SR与局部区域治疗[LRT]与最佳支持治疗）患者的总生存期。引入倾向评分匹配分析以减轻组间的混杂偏倚。
患者的中位生存时间从BCLC早期、中期到晚期逐渐缩短（BCLC 0-A期为43[范围0-100]个月，BCLC B期为32[范围0-100]个月，BCLC C期为27[范围0-90]个月，均P<0.05）。接受SR的患者肝功能更好，肿瘤状态更有利，因此在不同BCLC分期下，其总生存期显著优于接受LRT或最佳支持治疗的患者。在倾向评分匹配后的调整队列中，在不同BCLC分期下，接受手术治疗的患者始终比未接受根治性治疗的患者预后更好（中位生存时间[范围]：BCLC B期：切除组为45[0-100]个月，LRT组为36[0-81]个月，P=0.002；BCLC C期：切除组为39[3-77]个月，LRT组为27[0-54]个月，P=0.003）。
对于合适的HCC患者，无论BCLC分期如何，手术切除均应被视为一种根治性治疗方法。
