Shinkawa Hiroji, Tanaka Shogo, Takemura Shigekazu, Ito Tokuji, Aota Takanori, Koda Masaki, Miyazaki Toru, Yamamoto Takatsugu, Kubo Shoji
Department of Hepato-Biliary-Pancreatic Surgery Osaka City University Graduate School of Medicine Osaka Japan.
Department of Surgery Asakayama General Hospital Sakai Japan.
Ann Gastroenterol Surg. 2018 Jun 22;2(4):319-326. doi: 10.1002/ags3.12183. eCollection 2018 Jul.
Some patients who achieve a sustained virological response (SVR) to interferon (IFN) treatment for chronic hepatitis C prior to hepatic resection for hepatocellular carcinoma (HCC) experience postoperative recurrence. This study investigated the relationship between obesity and postoperative HCC recurrence in SVR patients.
Fifty-nine patients who had achieved SVR before hepatic resection were evaluated. Patients had a solitary tumor ≤5 cm in diameter or ≤3 lesions each ≤3 cm in size with no macroscopic vascular invasion (Milan criteria). Patient characteristics potentially associated with recurrence risk were investigated.
Three-, 5-, and 7-year recurrence-free survival after surgery were 65%, 44%, and 41%, respectively. Univariate analysis showed that obesity ( < .01), hypertension ( = .038), and non-anatomical resection ( = .022) were significantly associated with a lower recurrence-free survival rate. In a multivariate analysis, obesity (hazard ratio, 2.8; 95% confidence interval [CI] 1.3-6.1; < .01) and non-anatomical resection (hazard ratio, 2.7; 95% CI 1.1-6.2; = .025) were independently associated with postoperative recurrence. Three-, 5-, and 7-year overall survival rates after surgery were 100%, 80%, and 64% in obese patients and 100%, 92%, and 82% in non-obese patients, respectively ( = .014). However, other variables showed no significant difference in the overall survival rate.
Obesity and non-anatomical resection were independent risk factors for HCC recurrence after hepatic resection and successful IFN therapy. Obesity is an important clinical problem to consider to improve postoperative outcomes in such patients.
一些在肝细胞癌（HCC）肝切除术前接受干扰素（IFN）治疗慢性丙型肝炎获得持续病毒学应答（SVR）的患者会出现术后复发。本研究调查了SVR患者肥胖与术后HCC复发之间的关系。
对59例肝切除术前已获得SVR的患者进行评估。患者有直径≤5 cm的单个肿瘤或每个≤3 cm的≤3个病灶，且无肉眼可见血管侵犯（米兰标准）。研究了可能与复发风险相关的患者特征。
术后3年、5年和7年无复发生存率分别为65%、44%和41%。单因素分析显示，肥胖（<0.01）、高血压（=0.038）和非解剖性切除（=0.022）与较低的无复发生存率显著相关。多因素分析中，肥胖（风险比，2.8；95%置信区间[CI] 1.3 - 6.1；<0.01）和非解剖性切除（风险比，2.7；95% CI 1.1 - 6.2；=0.025）与术后复发独立相关。肥胖患者术后3年、5年和7年总生存率分别为100%、80%和64%，非肥胖患者分别为100%、92%和82%（=0.014）。然而，其他变量在总生存率方面无显著差异。
肥胖和非解剖性切除是肝切除及成功IFN治疗后HCC复发的独立危险因素。肥胖是改善此类患者术后结局需考虑的重要临床问题。
