Zakaria Hazem M, Macshut Mahmoud, Gaballa Nahla K, Sherif Ahmed E, Abdel-Samea Mohammed E, Abdel-Samiee Mohamed, Marwan Ibrahim, Yassein Taha
Department of Hepatopancreatobiliary and Liver Transplant Surgery, National Liver Institute, Menoufia University, Menoufia, Egypt.
Department of Anesthesia and Intensive Care, National Liver Institute, Menoufia University, Menoufia, Egypt.
Ann Med Surg (Lond). 2020 Apr 7;54:47-53. doi: 10.1016/j.amsu.2020.04.001. eCollection 2020 Jun.
Total tumor volume (TTV) can provide a simplified parameter in describing the tumor burden by incorporating the size and number of tumor nodules into one continuous variable. The aim of the study was to evaluate the prognostic value of TTV in resection of hepatocellular carcinoma (HCC).
Patients who underwent liver resection for HCC between 2012 and 2017 were retrospectively analyzed. Patients were divided into a group with TTV ≤65.5 cm³ (which nearly equal to a single tumor with a diameter of 5 cm), and another group with TTV > 65.5 cm³.
Two hundred and four patients were included in this study (108 patients had TTV ≤ 65.5cm3, and 96 patients had TTV > 65.5 cm³). Ninety patients (44.1%) were within Milan and 114 patients (55.9%) were beyond Milan criteria. Eighteen patients (15.8%) of beyond Milan criteria had TTV ≤ 65.5 cm³, with a median survival of 32 months which is comparable to a median survival of patients with TTV< 65.5 cm³ (38 months, = 0.38). TTV-based Cancer of Liver Italian Program (CLIP) score gained the highest value of likelihood ratio 114.7 and the highest Concordance-index 0.73 among other prognostic scoring and staging systems. In multivariate analysis, independent risk factors for diminished survival were serum AFP level >400 ng/ml, TTV >65.5 cm³, microvascular invasion, postoperative decompensation (all values < 0.05).
TTV is a feasible prognostic measure to describe the tumor burden in patients with HCC. TTV-CLIP score may provide good prognostic value for resection of HCC than other staging systems.
总肿瘤体积（TTV）通过将肿瘤结节的大小和数量整合为一个连续变量，可为描述肿瘤负荷提供一个简化参数。本研究的目的是评估TTV在肝细胞癌（HCC）切除术中的预后价值。
对2012年至2017年间接受HCC肝切除术的患者进行回顾性分析。患者被分为TTV≤65.5 cm³组（几乎等同于直径为5 cm的单个肿瘤）和TTV>65.5 cm³组。
本研究共纳入204例患者（108例患者TTV≤65.5 cm³，96例患者TTV>65.5 cm³）。90例患者（44.1%）符合米兰标准，114例患者（55.9%）超出米兰标准。超出米兰标准的患者中有18例（15.8%）TTV≤65.5 cm³，其中位生存期为32个月，与TTV<65.5 cm³患者的中位生存期（38个月，P=0.38）相当。在其他预后评分和分期系统中，基于TTV的意大利肝癌项目（CLIP）评分获得了最高的似然比114.7和最高的一致性指数0.73。在多变量分析中，生存时间缩短的独立危险因素为血清甲胎蛋白水平>400 ng/ml、TTV>65.5 cm³、微血管侵犯、术后失代偿（所有P值<0.05）。
TTV是描述HCC患者肿瘤负荷的一种可行的预后指标。与其他分期系统相比，TTV-CLIP评分可能为HCC切除术提供良好的预后价值。
