Christou Chrysanthos D, Tooulias Andreas, Tsolakidis Alexandros, Papayiannis Vassilis, Pianetcki-Tsiantzi Bozidaria, Tsoulfas Georgios, Papadopoulos Vasileios N
Department of First General Surgery, Papageorgiou General Hospital, Thessaloniki, Greece.
Department of Radiology, Papageorgiou General Hospital, Thessaloniki, Greece.
Ochsner J. 2020 Fall;20(3):272-278. doi: 10.31486/toj.19.0092.
The treatment of hepatocellular carcinoma (HCC) in the era of individualized therapy mandates a multidisciplinary approach and therefore the cooperation of physicians from multiple medical specialties. Treatment selection is based on the stage of the disease. The most prominent staging system is the Barcelona Clinic Liver Cancer (BCLC) classification system. We conducted a retrospective cohort study of patients with HCC treated in our department. Patients were originally staged based on the BCLC classification system. However, a multidisciplinary team refined the BCLC classes, using clinical data and biomarkers to tailor an individualized course of treatment. The study population was 63 patients who were BCLC staged at diagnosis as follows: very early (5 patients, 7.9%), early (38 patients, 60.3%), intermediate (14 patients, 22.2%), and advanced (6 patients, 9.5%). Thirty-two patients (50.8%) were treated with surgery and 31 patients (49.2%) with locoregional treatments. The 1-year, 3-year, and 5-year survival rates in the surgery group were 81.3%, 52.9%, and 18.9%, respectively, whereas in the locoregional treatment group, the 1-year, 3-year, and 5-year survival rates were 71.0%, 38.7%, and 19.0%, respectively. The mean overall survival was 35.42 ± 23.54 months for the surgery group and 28.42 ± 23.0 months for the locoregional treatment group. In the surgery group, the mean overall survival of the patients treated with surgery alone was 26.68 ± 21.97 months compared to 48.18 ± 20.26 months for the patients treated with surgery followed by locoregional treatment for recurrence. In this study, patients treated with hepatic resection had higher survival rates than patients treated with locoregional treatments. However, this superiority did not reach statistical significance (=0.426). Thus, locoregional treatments are highlighted as a valuable alternative to surgery, particularly when hepatic resection is not feasible. Finally, patients who received locoregional treatment following surgery had significantly higher survival compared to patients treated with surgery alone (=0.038).
个体化治疗时代的肝细胞癌（HCC）治疗需要多学科方法，因此需要多个医学专科的医生合作。治疗方案的选择基于疾病分期。最著名的分期系统是巴塞罗那临床肝癌（BCLC）分类系统。我们对在我科接受治疗的HCC患者进行了一项回顾性队列研究。患者最初根据BCLC分类系统进行分期。然而，一个多学科团队利用临床数据和生物标志物对BCLC分期进行细化，以制定个体化的治疗方案。研究人群为63例确诊时BCLC分期如下的患者：极早期（5例，7.9%）、早期（38例，60.3%）、中期（14例，22.2%）和晚期（6例，9.5%）。32例患者（50.8%）接受了手术治疗，31例患者（49.2%）接受了局部区域治疗。手术组的1年、3年和5年生存率分别为81.3%、52.9%和18.9%，而局部区域治疗组的1年、3年和5年生存率分别为71.0%、38.7%和19.0%。手术组的平均总生存期为35.42±23.54个月，局部区域治疗组为28.42±23.0个月。在手术组中，单纯接受手术治疗的患者平均总生存期为26.68±21.97个月，而接受手术治疗后因复发接受局部区域治疗的患者为48.18±20.26个月。在本研究中，接受肝切除治疗的患者生存率高于接受局部区域治疗的患者。然而，这种优势未达到统计学显著性（P=0.426）。因此，局部区域治疗被视为手术的一种有价值的替代方案，尤其是在肝切除不可行时。最后，与单纯接受手术治疗的患者相比，手术后接受局部区域治疗的患者生存率显著更高（P=0.038）。
