Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
J Gastrointest Surg. 2020 Aug;24(8):1809-1817. doi: 10.1007/s11605-019-04339-1. Epub 2019 Aug 5.
This study aimed to evaluate survival outcomes in patients with non-B non-C hepatocellular carcinoma (NBNC-HCC) with reference to patients with HCC achieving sustained virological response (SVR) by preoperative interferon (IFN) treatment for chronic hepatitis C.
We examined 781 patients who underwent hepatic resection for HCC. They were classified into NBNC-HCC, SVR-HCC, and non-SVR HCC groups.
Multivariate analysis for recurrence-free survival (RFS) and overall survival (OS) revealed that the adjusted hazard ratios (HR) of NBNC-HCC and non-SVR HCC groups with reference to the SVR-HCC group were 1.46 (p = 0.10) and 2.10 (p < 0.001), respectively, for RFS, and 1.69 (p = 0.024) and 2.11 (p < 0.001), respectively, for OS. Worsening of Child-Pugh grade at recurrence was confirmed in 21 patients (17.1%) with NBNC-HCC but not in those with SVR-HCC (p = 0.017, SVR vs. NBNC). In the NBNC-HCC group, hepatic resection for intrahepatic recurrence was adopted in 17.4% of patients without worsening of Child-Pugh grade at recurrence, whereas hepatic resection was not adopted in those with grade worsening. Among patients with alcoholic hepatitis, Child-Pugh grade worsening at recurrence was more frequently observed in patients with sobriety than those without sobriety (14.3% vs. 46.2%, p = 0.049).
NBNC-HCC patients had an increased risk for overall death as compared with those with SVR-HCC. Worsening of background liver function may reduce the chances of re-hepatic resection for recurrence and increase the risk for overall death in NBNC-HCC patients. For alcoholic hepatitis patients, sobriety may prevent deterioration of liver function after surgery.
本研究旨在评估术前接受干扰素（IFN）治疗慢性丙型肝炎实现持续病毒学应答（SVR）的患者与非乙型非丙型肝细胞癌（NBNC-HCC）患者的生存结局。
我们检查了 781 例接受 HCC 肝切除术的患者。他们被分为 NBNC-HCC、SVR-HCC 和非 SVR HCC 组。
多变量分析复发无进展生存（RFS）和总生存（OS）显示，与 SVR-HCC 组相比，NBNC-HCC 和非 SVR HCC 组的调整后的风险比（HR）分别为 1.46（p=0.10）和 2.10（p<0.001），用于 RFS，分别为 1.69（p=0.024）和 2.11（p<0.001），用于 OS。在 NBNC-HCC 组中，21 例（17.1%）患者在复发时出现 Child-Pugh 分级恶化，但在 SVR-HCC 组中未出现（p=0.017，SVR 与 NBNC）。在 NBNC-HCC 组中，在没有复发时 Child-Pugh 分级恶化的患者中，17.4%的患者接受了肝内复发的肝切除术，而在分级恶化的患者中则没有接受肝切除术。在酒精性肝炎患者中，在复发时出现肝功能恶化的患者中，戒酒的患者比不戒酒的患者更常见（14.3%比 46.2%，p=0.049）。
与 SVR-HCC 患者相比，NBNC-HCC 患者的总体死亡风险增加。背景肝功能恶化可能会降低 NBNC-HCC 患者再次肝切除治疗复发的机会，并增加其总体死亡风险。对于酒精性肝炎患者，戒酒可能会防止手术后肝功能恶化。
