Lee Juhyeon, Cho Eung-Ho, Kim Sang Bum, Kim Ryounggo
Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea.
Department of Surgery, Dongnam Institution of Radiological & Medical Sciences, Busan, Korea.
Ann Hepatobiliary Pancreat Surg. 2020 Nov 30;24(4):431-436. doi: 10.14701/ahbps.2020.24.4.431.
BACKGROUNDS/AIMS: Intrahepatic recurrence is frequent result after hepatectomy for hepatocellular carcinoma (HCC). We analyzed the clinical results of patients who had the intrahepatic recurrences of HCC after curative surgical resections.
From January 2009 to December 2016, 320 patients underwent curative surgical resection for HCC in department of Surgery, Korea Cancer Center Hospital. After surgical resection, 155 patients had suffered HCC recurrence during follow-up period. Among them, 122 patients had only intrahepatic recurrence initially, who were included in this retrospective study. We analyzed about the period of the recurrence after surgery, treatment methods for the recurred tumors, and poor prognostic factors for survival after intrahepatic recurrences.
Among the 122 patients, 83 patients had recurrence within 24 months after surgery. Thirty-eight patients underwent curative treatment for the recurred tumors (re-resection in 18, radiofrequency ablation in 20 patients). Non-curative treatments were performed in 77 patients (TACE in 68 patients, radiotherapy in 9 patients) and conservative management in 7 patients. Five-year survival rate of patients who underwent curative treatment is 86.4% (≤0.001). Five-year survival rate of non-curative treatment is 55.7% (≤0.001), conservative management is 0% (=0.021). Among the clinical factors, non-curative treatment for recurred tumor, AFP level at the time of recurrence, size of recurred tumor were independent poor prognostic factors for survival after intrahepatic recurrences (<0.001).
For the patients who had intrahepatic recurrent HCC after surgery, aggressive local treatment can improve the prognosis in selective cases. Further study is necessary to validate this retrospective investigation.
背景/目的：肝细胞癌（HCC）肝切除术后肝内复发很常见。我们分析了根治性手术切除后发生HCC肝内复发患者的临床结果。
2009年1月至2016年12月，韩国癌症中心医院外科有320例患者接受了HCC根治性手术切除。手术切除后，155例患者在随访期间出现HCC复发。其中，122例患者最初仅发生肝内复发，被纳入本回顾性研究。我们分析了术后复发时间、复发肿瘤的治疗方法以及肝内复发后生存的不良预后因素。
122例患者中，83例在术后24个月内复发。38例患者对复发肿瘤进行了根治性治疗（18例行再次切除，20例行射频消融）。77例患者接受了非根治性治疗（68例行经动脉化疗栓塞，9例行放疗），7例患者接受了保守治疗。接受根治性治疗患者的5年生存率为86.4%（≤0.001）。非根治性治疗的5年生存率为55.7%（≤0.001），保守治疗为0%（=0.021）。在临床因素中，复发肿瘤的非根治性治疗、复发时的甲胎蛋白水平、复发肿瘤大小是肝内复发后生存的独立不良预后因素（<0.001）。
对于术后发生肝内复发性HCC的患者，积极的局部治疗在选择性病例中可改善预后。需要进一步研究来验证这项回顾性调查。
