复发性肝细胞癌的外科治疗：实现长期生存。

Surgery for Recurrent Hepatocellular Carcinoma: Achieving Long-term Survival.

机构信息

Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

出版信息

Ann Surg. 2021 Apr 1;273(4):792-799. doi: 10.1097/SLA.0000000000003358.

DOI:10.1097/SLA.0000000000003358

PMID:31058698

Abstract

OBJECTIVE

To evaluate the long-term outcomes of surgery for recurrent hepatocellular carcinoma (HCC).

BACKGROUND

HCC recurs with high incidence after liver resection. Little is known about long-term outcomes of patients undergoing surgery for recurrent HCC.

METHODS

Among 989 patients who underwent R0/R1 liver resection for HCC between 1995 and 2014, 676 patients who exhibited recurrence were included. Repeat surgery was performed in 128 patients (RS group), and not in the remaining 548 patients (NS group). Prognostic value after repeat surgery was evaluated by comparing survival after recurrence (SAR) between the RS and NS groups. Subgroup analyses according to the 3 recurrence patterns [intrahepatic recurrence (IHR), extrahepatic recurrence (EHR), and intra plus extrahepatic recurrence (IHR + EHR)] were performed.

RESULTS

Seventy-three of 430 patients (17.0%) with IHR, 17 of 57 patients (29.8%) with EHR, and 38 of 189 patients (20.1%) with IH + EHR underwent repeat surgery. Compared with the NS group, the RS group had better liver function and their time to recurrence was significantly longer (16.5 vs 11.4 months; P < 0.001). In the overall and 3 recurrence patterns, the 5-year SAR rate was better in the RS group compared with the NS group (RS vs NS group; overall, 53.0% vs 25.7%; IHR, 73.8% vs 37.2%; EHR, 30.0% vs 0%; IHR + EHR, 34.1% vs 10.6%; all P < 0.001, respectively). On multivariate analysis, repeat surgery was identified as an independent factor for better SAR (P < 0.001).

CONCLUSION

Surgery for recurrent HCC may yield long-term survival for not only IHR but also for EHR in selected patients.

摘要

目的

评估复发性肝细胞癌（HCC）手术的长期疗效。

背景

HCC 切除术后复发率较高。对于接受复发性 HCC 手术的患者，其长期预后知之甚少。

方法

在 1995 年至 2014 年间接受 R0/R1 肝切除术治疗 HCC 的 989 例患者中，纳入 676 例出现复发的患者。128 例患者（RS 组）接受了再次手术，其余 548 例患者（NS 组）未接受再次手术。通过比较 RS 组和 NS 组复发后生存情况（SAR），评估再次手术后的预后价值。根据 3 种复发模式（肝内复发（IHR）、肝外复发（EHR）和 IHR+EHR）进行亚组分析。

结果

430 例 IHR 患者中有 73 例（17.0%）、57 例 EHR 患者中有 17 例（29.8%）、189 例 IHR+EHR 患者中有 38 例（20.1%）接受了再次手术。与 NS 组相比，RS 组肝功能更好，复发时间明显更长（16.5 个月 vs 11.4 个月；P<0.001）。在总体和 3 种复发模式中，RS 组的 5 年 SAR 率均优于 NS 组（RS 组 vs NS 组；总体为 53.0% vs 25.7%；IHR 为 73.8% vs 37.2%；EHR 为 30.0% vs 0%；IHR+EHR 为 34.1% vs 10.6%；均 P<0.001）。多因素分析显示，再次手术是 SAR 更好的独立因素（P<0.001）。