Division of General Surgery, First Affiliated Hospital, Anhui Medical University, Hefei 230022, China.
Division of General Surgery, First Affiliated Hospital, Anhui Medical University, Hefei 230022, China.
Hepatobiliary Pancreat Dis Int. 2019 Dec;18(6):532-537. doi: 10.1016/j.hbpd.2019.09.001. Epub 2019 Sep 11.
Currently, hepatectomy remains the first-line therapy for hepatocellular carcinoma (HCC). However, surgery for patients with huge (>10 cm) HCCs is controversial. This retrospective study aimed to explore long-term survival after hepatectomy for patients with huge HCC.
The records of 188 patients with pathologically confirmed HCC who underwent curative hepatectomy between 2007 and 2017 were reviewed; patients were divided into three groups according to tumor size: huge (>10 cm; n = 84), large (5-10 cm; n = 51) and small (<5 cm; n = 53) HCC. Kaplan-Meier analysis was used to assess overall survival (OS) and disease-free survival (DFS), and log-rank analysis was performed for pairwise comparisons among the three groups. Risk factors for survival and recurrence were analyzed using the Cox proportional hazard model.
The median follow-up period was 20 months. Although the prognosis of small HCC was better than that of huge and large HCC, OS and DFS were not significantly different between huge and large HCC (P = 0.099 and P = 0.831, respectively). A family history of HCC, poor Child-Pugh class, vascular invasion, diolame, pathologically positive margins, and operative time ≥240 min were identified as independent risk factors for OS and DFS in a multivariate model. Tumor size (>10 cm) had significant effect on OS, and postoperative antiviral therapy and postoperative complications also had significant effects on DFS.
Huge HCC is not a contraindication of hepatectomy. Although most of these patients experienced recurrence after surgery, OS and DFS were not significantly different from those of patients with large HCC after resection.
目前，肝切除术仍然是肝细胞癌（HCC）的一线治疗方法。然而，对于巨大（> 10cm）HCC 患者的手术仍存在争议。本回顾性研究旨在探讨巨大 HCC 患者肝切除术后的长期生存情况。
回顾性分析 2007 年至 2017 年间接受根治性肝切除术的 188 例病理证实 HCC 患者的记录；根据肿瘤大小将患者分为三组：巨大（> 10cm；n = 84）、大（5-10cm；n = 51）和小（<5cm；n = 53）HCC。采用 Kaplan-Meier 分析评估总生存（OS）和无病生存（DFS），并采用对数秩检验进行三组间的两两比较。采用 Cox 比例风险模型分析生存和复发的危险因素。
中位随访时间为 20 个月。尽管小 HCC 的预后优于巨大 HCC 和大 HCC，但巨大 HCC 和大 HCC 的 OS 和 DFS 无显著差异（P=0.099 和 P=0.831）。在多因素模型中，HCC 家族史、较差的 Child-Pugh 分级、血管侵犯、Diolame、病理阳性切缘和手术时间≥240min 被确定为 OS 和 DFS 的独立危险因素。肿瘤大小（> 10cm）对 OS 有显著影响，术后抗病毒治疗和术后并发症对 DFS 也有显著影响。
巨大 HCC 不是肝切除术的禁忌证。尽管这些患者大多数在手术后复发，但切除后 OS 和 DFS 与大 HCC 患者无显著差异。
