Sempokuya Tomoki, Wong Linda L
Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, HI 96813 , USA.
Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, NE 68198, USA.
Hepatoma Res. 2019;5. doi: 10.20517/2394-5079.2019.013. Epub 2019 Oct 13.
Long-term survival after hepatocellular cancer (HCC) is difficult to achieve likely related to recurrence. This study aimed to identify factors that were predictive of 10-year survival after the diagnosis of HCC.
In a prospectively collected database of 1374 HCC cases (1993-2019), we identified 70 patients who survived over 10 years regardless of treatment. We then identified 164 patients in the entire cohort who either had liver resection or transplant, and died before 10 years. Demographics, tumor characteristics, treatment, recurrence and treatment of recurrence were compared.
Of the 10-year survivors, 36 underwent transplant, 27 had liver resection and 7 patients had only locoregional therapy. Compared to the non-survivors, the 10-year survivors were younger and had fewer comorbidities or recurrence, smaller tumor size, lower AST, ALT, AFP, platelets, neutrophil-to-lymphocyte ratio. Multivariate analysis showed only age and diabetes to be negative predictors. Recurrence occurred in 24 survivors (34.3%) with mean time to recurrence with standard deviation 57.1 ± 42.6 months compared to 80 non-survivors (48.7%) with mean time to recurrence of 15.3 ± 14.8 months. For hepatic resection, 10-year survivors had longer time to recurrence compared to non-survivors (median: 31.3 months).
Long-term survivors mostly occur after resection or transplant, but 10% of our cohort survived 10 years with only locoregional therapy. Underlying health status maybe an important predictor of 10-year survival for patients receiving liver resections. Recurrence of HCC occurs in both 10-year survivors and non-survivors, but later recurrence with aggressive treatment of the recurrence may allow for 10-year survival.
肝细胞癌（HCC）很难实现长期生存，这可能与复发有关。本研究旨在确定诊断HCC后预测10年生存率的因素。
在一个前瞻性收集的包含1374例HCC病例（1993 - 2019年）的数据库中，我们确定了70例无论接受何种治疗均存活超过10年的患者。然后，我们在整个队列中确定了164例接受肝切除或移植且在10年前死亡的患者。比较了人口统计学、肿瘤特征、治疗、复发及复发治疗情况。
在10年生存者中，36例接受了移植，27例接受了肝切除，7例仅接受了局部治疗。与非生存者相比，10年生存者更年轻，合并症或复发更少，肿瘤尺寸更小，谷草转氨酶（AST）、谷丙转氨酶（ALT）、甲胎蛋白（AFP）、血小板、中性粒细胞与淋巴细胞比值更低。多因素分析显示只有年龄和糖尿病是阴性预测因素。24例生存者（34.3%）出现复发，复发的平均时间及标准差为57.1±42.6个月，相比之下，80例非生存者（48.7%）复发的平均时间为15.3±14.8个月。对于肝切除，10年生存者的复发时间比非生存者更长（中位数：31.3个月）。
长期生存者大多出现在肝切除或移植后，但我们队列中有10%的患者仅通过局部治疗存活了10年。基础健康状况可能是接受肝切除患者10年生存率的重要预测因素。HCC复发在10年生存者和非生存者中均会发生，但复发后积极治疗且复发时间较晚可能使患者存活10年。
