Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438, China.
Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438, China.
Int J Surg. 2018 Aug;56:256-263. doi: 10.1016/j.ijsu.2018.06.020. Epub 2018 Jun 20.
The current study aimed to examine the long-term survival after partial hepatectomy for patients with BCLC intermediate stage hepatocellular carcinoma (HCC) stratified by the Bolondi's sub-staging model.
This cohort consisted of 360 patients with BCLC intermediate stage HCC who underwent partial hepatectomy between January 2008 and February 2010. Patients were stratified into 3 subgroups (B1-B3) based on the Bolondi's sub-staging model. The last follow-up was conducted at February 2014.
Of these patients, 166, 171 and 23 patients had B1, B2, and B3 sub-stage HCC, respectively. The postoperative 5-year Overall survival (OS) rate for patients with these three sub-stages was 49.5%, 33.7% and 12.9%, respectively (P < 0.001). Compared with the reported survival outcomes from previous studies which used transarterial chemoembolization (TACE) as first-line treatment, hepatectomy had a better median survival than TACE in B1 and B2 patients. On multivariable analysis, presence of esophageal and gastric varices, higher NDR score, presence of microvascular invasion, differentiation grade III-IV, and patterns of AFP decreases after surgery were the independent risk factors of OS in the sub-stages B1 and B2 patients. A nomogram which integrated all these independent risk factors was developed, with a C-index of 0.71 for OS prediction. The calibration curve showed an optimal agreement between prediction by the nomogram and actual observation.
The patients with intermediate stage HCC clarified as sub-stages B1 and B2 according to Bolondi's model had an optimal long-term survival following partial hepatectomy than TACE. Their postoperative prognosis could be accurately predicted by our proposed nomogram.
本研究旨在探讨根据 Bolondi 亚分期模型分层的 BCLC 中期肝细胞癌（HCC）患者行部分肝切除术的长期生存情况。
本队列纳入了 2008 年 1 月至 2010 年 2 月期间行部分肝切除术的 360 例 BCLC 中期 HCC 患者。根据 Bolondi 亚分期模型，患者分为 3 个亚组（B1-B3）。最后一次随访时间为 2014 年 2 月。
这 360 例患者中，B1、B2 和 B3 亚期 HCC 患者分别有 166、171 和 23 例。这三组患者术后 5 年总生存率（OS）分别为 49.5%、33.7%和 12.9%（P<0.001）。与之前采用经动脉化疗栓塞（TACE）作为一线治疗的研究报道的生存结果相比，在 B1 和 B2 患者中，肝切除术的中位生存时间优于 TACE。多变量分析显示，存在食管胃静脉曲张、较高的 NDR 评分、微血管侵犯、分化程度 III-IV 级和术后 AFP 降低模式是 B1 和 B2 亚组患者 OS 的独立危险因素。建立了一个包含所有这些独立危险因素的列线图，其 OS 预测的 C 指数为 0.71。校准曲线显示，列线图预测与实际观察之间具有最佳一致性。
根据 Bolondi 模型明确为 B1 和 B2 亚期的中期 HCC 患者行部分肝切除术的长期生存优于 TACE。我们提出的列线图可准确预测其术后预后。
