Klompenhouwer Anne J, van Rosmalen Belle V, Haring Martijn P D, Thomeer Maarten G J, Doukas Michail, Verheij Joanne, de Meijer Vincent E, van Gulik Thomas M, Takkenberg Robert B, Kazemier Geert, Nevens Frederik, de Man Robert A, Ijzermans Jan N M
Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam (Location Academic Medical Center), Amsterdam, The Netherlands.
Liver Int. 2020 Sep;40(9):2272-2278. doi: 10.1111/liv.14467. Epub 2020 Apr 28.
BACKGROUND & AIMS: Hepatocellular adenoma (HCA) is a benign liver tumour that may require resection in select cases. The aim of this study was to the assess growth of residual HCA in the remnant liver and to advise on an evidence-based management strategy.
This multicentre retrospective cohort study included all patients with HCA who underwent surgery of HCA and had residual HCA in the remnant liver. Growth was defined as an increase of >20% in transverse diameter (RECIST criteria). Data on patient and HCA characteristics, diagnostic work-up, treatment and follow-up were documented and analysed.
A total of 134 patients were included, one male. At diagnosis, median age was 38yrs (IQR 30.0-44.0) and median BMI was 29.9 kg/m (IQR 24.6-33.3). After resection, median number of residual sites of HCA was 3 (IQR 2-6). Follow-up of residual HCA showed regression in 24.6%, stable HCA in 61.9% and growth of at least one lesion in 11.2%. Three patients (2.2%) developed new HCA that were not visible on imaging prior to surgery. Four patients (3%, one male) underwent an intervention as growth was progressive. No statistically significant differences in clinical characteristics were found between patients with growing residual or new HCA versus those with stable or regressing residual HCA.
In patients with multiple HCA who undergo resection, growth of residual HCA is not uncommon but interventions are rarely needed as most lesions stabilize and do not show progressive growth. Surveillance is indicated when residual HCA show growth after resection, enabling intervention in case of progressive growth.
肝细胞腺瘤（HCA）是一种良性肝肿瘤，在某些情况下可能需要进行切除。本研究的目的是评估残余肝脏中残余HCA的生长情况，并提出基于证据的管理策略建议。
这项多中心回顾性队列研究纳入了所有接受HCA手术且残余肝脏中存在残余HCA的患者。生长定义为横径增加>20%（RECIST标准）。记录并分析了患者和HCA特征、诊断检查、治疗及随访数据。
共纳入134例患者，其中1例男性。诊断时，中位年龄为38岁（四分位间距30.0 - 44.0），中位BMI为29.9 kg/m²（四分位间距24.6 - 33.3）。切除术后，残余HCA的中位部位数为3个（四分位间距2 - 6）。对残余HCA的随访显示，24.6%出现消退，61.9%稳定，11.2%至少有一个病灶生长。3例患者（2.2%）出现术前影像学检查不可见的新发HCA。4例患者（3%，1例男性）因病情进展接受了干预。残余或新发HCA生长的患者与残余HCA稳定或消退的患者在临床特征上未发现统计学显著差异。
在接受切除的多灶性HCA患者中，残余HCA生长并不罕见，但由于大多数病灶稳定且无进展性生长，很少需要干预。切除术后残余HCA出现生长时需进行监测，以便在病情进展时进行干预。
