Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan.
Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan.
Ann Surg. 2020 Jul;272(1):145-154. doi: 10.1097/SLA.0000000000003192.
The aim of the study was to evaluate the survival benefits of liver resection (LR) compared with transarterial chemoembolization (TACE) for patients with multiple hepatocellular carcinomas (HCCs).
Despite significant improvements in diagnostic imaging and the widespread application of screening programs, some patients with HCC continue to present with multiple tumors. The surgical indications for multiple HCCs remain controversial.
Among 77,268 patients with HCC reported in a Japanese nationwide survey, 27,164 patients had multiple HCCs. The exclusion criteria were Child-Pugh B/C, treatment other than LR and TACE, >3 tumors, and insufficient available data. Ultimately, 3246 patients (LR: n = 1944, TACE: n = 1302) were included. The survival benefit of LR for patients multiple HCCs was evaluated by using propensity score matching analysis.
The study group of 2178 patients (LR: n = 1089, TACE: n = 1089) seemed to be well matched. The overall survival rate in the LR group was 60.0% at 5 years, which was higher than that in the TACE group (41.6%, P < 0.001). Among patients with a tumor size of 30 mm or more, LR showed a survival benefit over TACE at 5 years (53.0% vs 32.7%, P < 0.001). The multivariate analysis indicated that age, serum albumin level, serum alpha-fetoprotein (AFP) level, macrovascular invasion, tumor size, and TACE were independent predictors of poor prognosis in multiple HCCs.
LR could offer better long-term survival than TACE for patients with multiple HCCs (up to 3 tumors). If patients have good liver function (Child-Pugh A), LR is recommended, even for those with multiple HCCs with tumor sizes of 30 mm or more.
本研究旨在评估与经动脉化疗栓塞术（TACE）相比，肝切除术（LR）对多肝细胞癌（HCC）患者的生存获益。
尽管诊断成像技术有了显著进步，且广泛应用了筛查计划，但一些 HCC 患者仍表现为多个肿瘤。多 HCC 的手术适应证仍存在争议。
在日本全国性调查中报告的 77268 例 HCC 患者中，有 27164 例患者有多发性 HCC。排除标准为 Child-Pugh B/C、LR 和 TACE 以外的治疗、>3 个肿瘤和数据不足。最终纳入 3246 例患者（LR：n=1944，TACE：n=1302）。采用倾向评分匹配分析评估 LR 对多 HCC 患者的生存获益。
2178 例患者（LR：n=1089，TACE：n=1089）的研究组似乎匹配良好。LR 组的总体 5 年生存率为 60.0%，高于 TACE 组（41.6%，P<0.001）。在肿瘤直径为 30mm 或更大的患者中，LR 在 5 年时的生存获益优于 TACE（53.0%比 32.7%，P<0.001）。多因素分析表明，年龄、血清白蛋白水平、血清甲胎蛋白（AFP）水平、大血管侵犯、肿瘤大小和 TACE 是多 HCC 预后不良的独立预测因素。
LR 可为多 HCC 患者（多达 3 个肿瘤）提供比 TACE 更好的长期生存。如果患者肝功能良好（Child-Pugh A），即使对于肿瘤直径为 30mm 或更大的多 HCC 患者，也推荐使用 LR。
