Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Boston, MA, 02114-3117, USA.
Department of Surgery, University of Wisconsin, Madison, WI, USA.
J Gastrointest Surg. 2019 Jun;23(6):1135-1142. doi: 10.1007/s11605-018-3946-z. Epub 2018 Sep 14.
There is no consensus regarding the optimal surgical treatment for transplantable hepatocellular carcinoma (HCC) patients with well-compensated cirrhosis. Our aim was to compare outcomes between Child-Pugh A (CPA) cirrhotics who underwent liver resection or transplantation for HCC.
Clinicopathologic data were retrospectively collected for all surgically treated HCC patients between 7/1992 and 12/2015. Disease-free survival (DFS) and overall survival (OS) were calculated from the time of operation or diagnosis (intention-to-treat analysis including patients removed from the transplant list). The average overall cost including pre-operative and post-operative procedures was calculated for each group.
Of the 513 surgically treated HCC patients, 184 had CPA cirrhosis and fulfilled the Milan criteria (MC). Of those, 95 (52%) were resected and 89 (48%) were transplanted. Twenty-two patients were removed from the transplant list. Transplanted patients were younger (p < 0.001), had a higher MELD score (p < 0.001) and a higher frequency of hepatitis C (p < 0.001). Length of stay and postoperative complication rates were similar between groups. DFS was longer for transplanted patients (3-, 5-, and 10-year DFS rates 48, 44, 31% vs 96, 94, 94%, respectively, p < 0.001). OS was similar between groups (3-, 5-, and 10-year OS rates 76, 62, 41% vs 82, 77, 53%, respectively, p = 0.07). Only size of greatest lesion and T stage were independent predictors of OS. The cost was much higher for the transplant group, even when accounting for the treatment of recurrences ($37,391 vs $137,996).
Since OS is similar between CPA cirrhotics within the MC undergoing resection or transplantation for HCC, but cost is significantly higher for transplantation. Resection should be considered for first-line treatment.
对于伴有代偿性肝硬化的可移植肝细胞癌（HCC）患者，目前尚无关于最佳手术治疗方法的共识。我们的目的是比较行肝切除术或肝移植术治疗 HCC 的 Child-Pugh A（CPA）肝硬化患者的结局。
回顾性收集了 1992 年 7 月至 2015 年 12 月期间所有接受 HCC 手术治疗的患者的临床病理资料。无病生存期（DFS）和总生存期（OS）从手术或诊断时间（包括从移植名单中剔除的患者的意向治疗分析）开始计算。计算每组患者的术前和术后平均总费用。
在 513 例接受手术治疗的 HCC 患者中，有 184 例患有 CPA 肝硬化并符合米兰标准（MC）。其中，95 例（52%）接受了肝切除术，89 例（48%）接受了肝移植术。22 例患者从移植名单中剔除。移植组患者更年轻（p<0.001），MELD 评分更高（p<0.001），丙型肝炎发生率更高（p<0.001）。两组患者的住院时间和术后并发症发生率相似。移植组患者的 DFS 更长（3 年、5 年和 10 年 DFS 率分别为 48%、44%和 31%，而 96%、94%和 94%，p<0.001）。两组患者的 OS 无差异（3 年、5 年和 10 年 OS 率分别为 76%、62%和 41%，78%、77%和 53%，p=0.07）。只有最大肿瘤直径和 T 分期是 OS 的独立预测因素。即使考虑到复发的治疗费用，移植组的费用仍然高得多（37391 美元比 137996 美元）。
由于在 MC 范围内接受肝切除术或肝移植术治疗的 CPA 肝硬化患者的 OS 相似，但移植的费用明显更高，因此肝切除术应作为一线治疗方法。
