Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
PLoS One. 2020 Mar 27;15(3):e0230897. doi: 10.1371/journal.pone.0230897. eCollection 2020.
BACKGROUND & AIMS: In 2012, the Barcelona Clinic Liver Cancer (BCLC) system designated a single large hepatocellular carcinoma (SLHCC) (>5 cm) as BCLC stage A rather than stage B. However, a recent study from western countries reported that prognosis following liver resection (LR) among patients with SLHCC was similar to that among patients with BCLC stage B. We aim to evaluate the prognosis following LR among patients with SLHCC from an Asian high-volume liver surgery center.
Patients who underwent curative-intent LR for histologically proven HCC between 2011 and 2017 were enrolled using an HCC registry database. Overall survival (OS) among patients with BCLC stages 0, A, and B was examined. Patients with a SLHCC were classified as BCLC stage A1.
Among 543 patients, 89 (16.4%) were BCLC stage 0, 289 (53.2%) were BCLC stage A, 92 (16.9%) were BCLC stage A1, and 73 (13.4%) were BCLC stage B. The median follow-up was 38 months. The five-year OS rates among patients with BCLC stages 0, A, A1, and B were 83.5%, 83.7%, 77.4%, and 55.4%, respectively (p<0.001). No difference in OS was noted for patients with BCLC stage A versus A1 (p = 0.11), even after adjusting for competing factors (hazard ratio = 0.97, 95% confidence interval = 0.53-1.79; p = 0.93).
Prognosis following LR among patients with SLHCC was similar to that among patients with BCLC stage A. The prognosis for SLHCC should thus be considered comparable to that for BCLC stage A.
2012 年，巴塞罗那临床肝癌（BCLC）系统将单个大肝癌（SLHCC）（>5cm）指定为 BCLC 期 A，而非期 B。然而，最近来自西方国家的一项研究报告称，对于 SLHCC 患者行肝切除术（LR）后的预后与 BCLC 期 B 患者相似。我们旨在评估来自亚洲高容量肝脏手术中心的 SLHCC 患者行 LR 后的预后。
我们使用 HCC 登记数据库纳入了 2011 年至 2017 年间接受根治性 LR 治疗的经组织学证实的 HCC 患者。我们检查了 BCLC 分期 0、A 和 B 患者的总生存期（OS）。将 SLHCC 患者分为 BCLC 分期 A1。
在 543 例患者中，89 例（16.4%）为 BCLC 分期 0，289 例（53.2%）为 BCLC 分期 A，92 例（16.9%）为 BCLC 分期 A1，73 例（13.4%）为 BCLC 分期 B。中位随访时间为 38 个月。BCLC 分期 0、A、A1 和 B 的患者五年 OS 率分别为 83.5%、83.7%、77.4%和 55.4%（p<0.001）。BCLC 分期 A 与 A1 患者的 OS 无差异（p=0.11），即使在校正竞争因素后（风险比=0.97，95%置信区间=0.53-1.79；p=0.93）。
SLHCC 患者行 LR 后的预后与 BCLC 分期 A 患者相似。因此，SLHCC 的预后应被认为与 BCLC 分期 A 相似。
