Schoenberg Markus Bo, Anger Hubertus Johann Wolfgang, Hao Jingcheng, Vater Adrian, Bucher Julian Nikolaus, Thomas Michael Nikolaus, Lauseker Michael, Rentsch Markus, Schiergens Tobias Simon, Angele Martin Kurt, Bazhin Alexandr V, Werner Jens, Guba Markus Otto
Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.
IBE (Institute for Biostatistics and Epidemiology), Ludwig-Maximilians-University, Munich, Germany.
Surg Oncol. 2018 Dec;27(4):663-673. doi: 10.1016/j.suronc.2018.08.007. Epub 2018 Aug 30.
To develop criteria for safe and oncologically satisfying liver resection in case of early hepatocellular carcinoma with a 5-year overall survival (OS) similar to liver transplantation.
Liver resection (LR) and liver transplantation (LT) are potentially curative treatment options for hepatocellular carcinoma. Generally, LT achieves better OS. Due to organ shortage, however not all patients can receive a LT.
To decide which patients to resect and which to transplant we have developed biological resection criteria (BRC) as a compound out of mGPS (modified Glascow Prognostic Scale) and the Kings-Score (for HCV cirrhosis). These are based on routine clinical values that reflect both liver function and tumor biology/immunology.
276 patients were analyzed. Patients undergoing LR within BRC (BRC) had a significantly better overall (73.6% vs. 35.4%, (p < 0.001)) and disease-free survival (54.7% vs. 17.2%, (p < 0.001)) as compared to patients outside the BRC (BRC). The predictive value of BRC was independent of tumor burden. In a subgroup analysis BRC patients had significantly worse outcome after major resection. In LT patients BRC had no predictive value.
BRC may be a valuable tool to predict survival after LR for HCC. Patients resected BRC may achieve comparable survival as LT. LR in BRC patients are unlikely to be curative. All BRC patients should be monitored closely for salvage LT.
制定早期肝细胞癌肝切除的安全及肿瘤学满意标准，使其5年总生存率与肝移植相似。
肝切除（LR）和肝移植（LT）是肝细胞癌潜在的治愈性治疗选择。一般来说，LT的总生存率更高。然而，由于器官短缺，并非所有患者都能接受LT。
为了决定哪些患者适合切除，哪些适合移植，我们制定了生物学切除标准（BRC），它是由改良格拉斯哥预后评分（mGPS）和金斯评分（用于丙型肝炎肝硬化）组合而成。这些标准基于反映肝功能和肿瘤生物学/免疫学的常规临床值。
对276例患者进行了分析。与不符合BRC标准的患者相比，符合BRC标准（BRC）接受LR的患者总生存率（73.6%对35.4%，（p<0.001））和无病生存率（54.7%对17.2%，（p<0.001））显著更高。BRC的预测价值与肿瘤负荷无关。在亚组分析中，BRC患者在大切除术后的预后明显更差。在LT患者中，BRC没有预测价值。
BRC可能是预测肝癌LR术后生存的有价值工具。接受LR的BRC患者可能获得与LT相当的生存率。BRC患者的LR不太可能治愈。所有BRC患者都应密切监测，以便进行挽救性LT。
