大型肝细胞癌：纤维化真的会影响切除术后的预后吗？

Large hepatocellular carcinoma: Does fibrosis really impact prognosis after resection?

作者信息

Golse N, El Bouyousfi A, Marques F, Bancel B, Mohkam K, Ducerf C, Merle P, Sebagh M, Castaing D, Sa Cunha A, Adam R, Cherqui D, Vibert E, Mabrut J-Y

机构信息

Liver Transplantation and Hepato-Biliary Surgery, centre hépato-biliaire, hôpital Paul-Brousse, université Paris-Sud, Assistance publique-Hôpitaux Paris, 12, avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.

Hospices civils de Lyon, Digestive Surgery and Liver Transplant Department, Croix-Rousse Hospital, 69004 Lyon, France.

出版信息

J Visc Surg. 2018 Sep;155(4):265-273. doi: 10.1016/j.jviscsurg.2017.10.015. Epub 2018 Mar 7.

DOI:10.1016/j.jviscsurg.2017.10.015

PMID:29525540

Abstract

BACKGROUND

Hepatectomy remains the standard treatment for large hepatocellular carcinoma (LHCC) ≥5cm. Fibrosis may constitute a contraindication for resection because of high risk of post-hepatectomy liver failure, but its impact on patient outcome and cancer recurrence remains ill defined. Our aim was to compare predictors of survival in patients with and without cirrhosis following hepatectomy for LHCC.

METHODS

The data on consecutive patients undergoing hepatectomy for LHCC in two tertiary centres between 2012 and 2016 were reviewed. The outcomes of cirrhotic (F4) and non-cirrhotic (F0-F3) patients were compared. Patients with perioperative medical (sorafenib) or radiological (transarterial chemoembolization, radiofrequency) treatments were excluded.

RESULTS

Sixty patients were included. Preoperative and intraoperative features were identical between both groups. Cirrhotics (n=15) presented more satellite nodules on specimens (73% vs. 44%; P=0.073) but better differentiated lesions than non-cirrhotics (P=0.041). The median overall survival of cirrhotics was 34 vs. 29months for non-cirrhotics (P=0.8), and their disease-free survival was 14 versus 18 months (P=0.9). Fibrosis stage did not impact overall (P=0.2) nor disease-free survivals (P=0.6).

CONCLUSION

Hepatectomy for LHCC in cirrhotics can achieve acceptable oncological results when compared to non-cirrhotic patients. Curative resection of LHCC should be attempted if liver function is acceptable, whatever the fibrosis stage.

摘要

背景

肝切除术仍然是治疗直径≥5cm的大肝细胞癌（LHCC）的标准方法。由于肝切除术后肝衰竭风险高，纤维化可能构成手术切除的禁忌证，但其对患者预后和癌症复发的影响仍不明确。我们的目的是比较LHCC肝切除术后有肝硬化和无肝硬化患者的生存预测因素。

方法

回顾了2012年至2016年期间在两个三级中心接受LHCC肝切除术的连续患者的数据。比较了肝硬化（F4）和非肝硬化（F0 - F3）患者的预后。排除围手术期接受药物（索拉非尼）或放射治疗（经动脉化疗栓塞、射频）的患者。

结果

共纳入60例患者。两组患者的术前和术中特征相同。肝硬化患者（n = 15）标本上的卫星结节更多（73%对44%；P = 0.073），但与非肝硬化患者相比，病变分化更好（P = 0.041）。肝硬化患者的中位总生存期为34个月，非肝硬化患者为29个月（P = 0.8），无病生存期分别为14个月和18个月（P = 0.9）。纤维化分期对总生存期（P = 0.2）和无病生存期（P = 0.6）均无影响。