Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, 20 College Road, Singapore, 169608, Singapore.
Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore.
World J Surg. 2019 Oct;43(10):2587-2594. doi: 10.1007/s00268-019-05051-6.
Repeat liver resection (RLR) for recurrent HCC (rHCC) is a widely accepted treatment modality. However, early recurrence rate is high, frequently resulting in futile resection. We performed this study to evaluate preoperative factors, including the value of inflammatory indices, in predicting early (<1 year) recurrence in patients who underwent RLR for rHCC. This may help clinicians better select patients for RLR, while excluding cases in which RLR for rHCC would likely be futile.
This is a retrospective study of 80 patients where 90 operative cases of RLR and 84 cases of early recurrence (<1 year) post-RLR were evaluated. Preoperative predictors of early recurrence and overall survival (OS) were assessed.
There were 31 (34.4%) early recurrences with a 5-year OS of 38.9%. Elevated platelet-to-lymphocyte ratio (PLR) >103.6 was a significant independent preoperative predictor of both early recurrence, relative risk (RR) 4.284 (P = 0.001) and OS, RR 2.139 (P = 0.027), while alphafetoprotein (AFP) ≥ 200 was a significant independent preoperative predictor of early recurrence only, RR 11.655 (P = 0.030). Patients were followed-up at a median of 14.3 months with 54.8% developing intrahepatic recurrences and 19.4% developing extrahepatic recurrences.
Both, elevated PLR and AFP ≥ 200 were independent predictors of early (<1 year) recurrence after RLR for rHCC, while only an elevated PLR was an independent preoperative prognosticators of overall survival. Indication for RLR should be carefully discussed in patients with relapsed HCC with an elevated PLR, due to the potential of early recurrence and poor overall survival.
复发性肝细胞癌（rHCC）的再次肝切除术（RLR）是一种广泛接受的治疗方式。然而，早期复发率很高，经常导致无效切除。我们进行这项研究是为了评估术前因素，包括炎症指标的价值，以预测接受 rHCC 的 RLR 后早期（<1 年）复发的患者。这可能有助于临床医生更好地选择接受 RLR 的患者，同时排除 RLR 治疗 rHCC 可能无效的病例。
这是一项回顾性研究，共纳入 80 例患者，其中 90 例接受 RLR 手术，84 例在 RLR 后 1 年内早期复发。评估了早期复发和总生存期（OS）的术前预测因素。
有 31 例（34.4%）早期复发，5 年 OS 为 38.9%。血小板与淋巴细胞比值（PLR）升高（>103.6）是早期复发和 OS 的显著独立术前预测因素，相对风险（RR）分别为 4.284（P=0.001）和 2.139（P=0.027），而甲胎蛋白（AFP）≥200ng/ml 仅为早期复发的显著独立术前预测因素，RR 为 11.655（P=0.030）。中位随访时间为 14.3 个月，54.8%的患者发生肝内复发，19.4%的患者发生肝外复发。
PLR 升高和 AFP≥200ng/ml 均为 rHCC 接受 RLR 后早期（<1 年）复发的独立预测因素，而只有 PLR 升高是 OS 的独立术前预测因素。对于复发 HCC 患者，由于早期复发和整体生存不良的潜在风险，应在仔细讨论 RLR 的适应证。
