Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Department of Radiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Eur J Surg Oncol. 2019 Dec;45(12):2360-2368. doi: 10.1016/j.ejso.2019.09.009. Epub 2019 Sep 12.
The Barcelona Clinic Liver Cancer (BCLC) categorizes a patient with performance status (PS)-1 as advanced stage of hepatocellular carcinoma (HCC) and surgical resection is not recommended. In real-world clinical practice, PS-1 is often not a contraindication to surgery for HCC. The aim of current study was to define the impact of PS on the surgical outcomes of patients undergoing liver resection for HCC.
1,531 consecutive patients who underwent a curative-intent resection of HCC between 2005 and 2015 were identified using a multi-institutional database. After categorizing patients into PS-0 (n = 836) versus PS-1 (n = 695), perioperative mortality and morbidity, overall survival (OS) and recurrence-free survival (RFS) were compared.
Overall perioperative mortality and major morbidity among patients with PS-0 (n = 836) and PS-1 (n = 695) were similar (1.4% vs. 1.6%, P = 0.525 and 9.7% vs. 10.2%, P = 0.732, respectively). In contrast, median OS and RFS was worse among patients who had PS-1 versus PS-0 (34.0 vs. 107.6 months, and 20.5 vs. 60.6 months, both P < 0.001, respectively). On multivariable Cox-regression analyses, PS-1 was independently associated with worse OS (HR: 1.301, 95% CI: 1.111-1.523, P < 0.001) and RFS (HR: 1.184, 95% CI: 1.034-1.358, P = 0.007).
Patients with PS-1 versus PS-0 had comparable perioperative outcomes. However, patients with PS-1 had worse long-term outcomes as PS-1 was independently associated with worse OS and RFS. Routine exclusion of HCC patients with PS-1 from surgical resection as recommended by the BCLC guidelines is not warranted.
巴塞罗那临床肝癌（BCLC）将 PS-1 的患者归类为晚期肝细胞癌（HCC），不建议进行手术切除。但在实际临床实践中，PS-1 通常不是 HCC 手术的禁忌症。本研究旨在确定 PS 对接受 HCC 肝切除术患者手术结果的影响。
使用多机构数据库，确定了 2005 年至 2015 年间接受根治性肝切除术的 1531 例连续患者。将患者分为 PS-0（n=836）和 PS-1（n=695）两组后，比较围手术期死亡率和发病率、总生存率（OS）和无复发生存率（RFS）。
PS-0（n=836）和 PS-1（n=695）患者的总体围手术期死亡率和主要发病率相似（1.4% vs. 1.6%，P=0.525 和 9.7% vs. 10.2%，P=0.732）。相比之下，PS-1 患者的中位 OS 和 RFS 明显低于 PS-0 患者（34.0 与 107.6 个月，20.5 与 60.6 个月，均 P<0.001）。多变量 Cox 回归分析显示，PS-1 与 OS 不良独立相关（HR：1.301，95%CI：1.111-1.523，P<0.001）和 RFS（HR：1.184，95%CI：1.034-1.358，P=0.007）。
与 PS-0 患者相比，PS-1 患者的围手术期结果相似。然而，PS-1 患者的长期预后较差，因为 PS-1 与 OS 和 RFS 不良独立相关。因此，BCLC 指南建议将 PS-1 的 HCC 患者常规排除在手术切除之外是不合理的。
