Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy.
Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, University of Padova, Padova, Italy.
Liver Int. 2021 Feb;41(2):396-407. doi: 10.1111/liv.14718. Epub 2020 Nov 23.
BACKGROUND & AIMS: According to the Barcelona Clinic Liver Cancer (BCLC) staging system, monofocal hepatocellular carcinoma (HCC) is classified as early (BCLC A) irrespective of its size, even though controversies still exist regarding staging and treatment of large tumours. We aimed at evaluating the appropriate staging and treatment for large (>5 cm) monofocal (HCC).
From the Italian Liver Cancer database, we selected 924 patients with small early monofocal HCC (2-5 cm; SEM-HCC), 163 patients with larger tumours (>5 cm; LEM-HCC) and 1048 intermediate stage patients (BCLC B).
LEM-HCC patients had a worse overall survival (OS) than SEM-HCC (31.0 vs 49.0 months; P < .0001), and this was confirmed at multivariate analysis (HR 1.63, 95% CI 1.29-2.05; P < .0001). The small difference in OS between LEM-HCC and BCLC B patients (31.0 vs 27.0 months; P = .03) disappeared in the multivariate model (HR 0.98, 95% CI 0.77-1.25; P = .89). In all monofocal tumours, treatment was the strongest independent predictor of survival, with a progressively decreasing survival benefit moving from "curative" to "palliative" therapies. The survival of resected patients with LEM-HCC was significantly shorter than that of SEM-HCC (44.0 vs 78.0 months; P = .002), but liver resection provided the highest survival benefit in both groups compared to other treatments.
Monofocal HCC larger than 5 cm should not be staged as BCLC A and either a different staging system or a different subgrouping of patients (e.g. BCLC AB) should be used. Liver resection, if feasible, remains the recommended treatment for all these patients.
根据巴塞罗那临床肝癌（BCLC）分期系统，单灶性肝细胞癌（HCC）无论其大小均归类为早期（BCLC A），尽管在大肿瘤的分期和治疗方面仍存在争议。我们旨在评估大（> 5 cm）单灶性（HCC）的适当分期和治疗方法。
我们从意大利肝癌数据库中选择了 924 名小的早期单灶性 HCC（2-5 cm；SEM-HCC）、163 名较大肿瘤（> 5 cm；LEM-HCC）和 1048 名中期患者（BCLC B）。
LEM-HCC 患者的总生存期（OS）明显差于 SEM-HCC（31.0 与 49.0 个月；P<.0001），多变量分析也证实了这一点（HR 1.63，95%CI 1.29-2.05；P<.0001）。LEM-HCC 和 BCLC B 患者 OS 之间的微小差异（31.0 与 27.0 个月；P=.03）在多变量模型中消失（HR 0.98，95%CI 0.77-1.25；P=.89）。在所有单灶性肿瘤中，治疗是生存的最强独立预测因素，从“治愈性”治疗到“姑息性”治疗，生存获益逐渐减少。LEM-HCC 切除患者的生存时间明显短于 SEM-HCC（44.0 与 78.0 个月；P=.002），但与其他治疗相比，肝切除术在两组患者中提供了最高的生存获益。
大于 5 cm 的单灶性 HCC 不应分期为 BCLC A，应使用不同的分期系统或患者的不同亚组（例如 BCLC AB）。如果可行，肝切除术仍然是所有这些患者的推荐治疗方法。
