Lee Han Pil, Yun Jae Kwang, Jung Hee Suk, Moon Duk Hwan, Lee Geun Dong, Choi Sehoon, Kim Yong-Hee, Kim Dong Kwan, Park Seung Il, Kim Hyeong Ryul
Department of Thoracic & Cardiovascular Surgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Republic of Korea.
Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
World J Surg Oncol. 2021 Jan 30;19(1):33. doi: 10.1186/s12957-021-02138-0.
The role of surgical intervention as a treatment for pulmonary metastasis (PM) from hepatocellular carcinoma (HCC) has not been established. In this study, we investigated the clinical outcomes of pulmonary metastasectomy. Using propensity score matching (PSM) analysis, we compared the results according to the surgical approach: video-assisted thoracic surgery (VATS) versus the open method.
A total of 134 patients (115 men) underwent pulmonary metastasectomy for isolated PM of HCC between January 1998 and December 2010 at Seoul Asan Medical Center. Of these, 84 underwent VATS (VATS group) and 50 underwent thoracotomy or sternotomy (open group). PSM analysis between the groups was used to match them based on the baseline characteristics of the patients.
During the median follow-up period of 33.4 months (range, 1.8-112.0), 113 patients (84.3%) experienced recurrence, and 100 patients (74.6%) died of disease progression. There were no overall survival rate, disease-free survival rate, and pulmonary-specific disease-free survival rate differences between the VATS and the open groups (p = 0.521, 0.702, and 0.668, respectively). Multivariate analysis revealed local recurrence of HCC, history of liver cirrhosis, and preoperative alpha-fetoprotein level as independent prognostic factors for overall survival (hazard ratio, 1.729/2.495/2.632, 95% confidence interval 1.142-2.619/1.571-3.963/1.554-4.456; p = 0.010/< 0.001/< 0.001, respectively).
Metastasectomy can be considered a potential alternative for selected patients. VATS metastasectomy had outcomes comparable to those of open metastasectomy.
手术干预作为肝细胞癌（HCC）肺转移（PM）的一种治疗方法，其作用尚未明确。在本研究中，我们调查了肺转移瘤切除术的临床结果。使用倾向评分匹配（PSM）分析，我们根据手术方式比较了结果：电视辅助胸腔镜手术（VATS）与开放手术方法。
1998年1月至2010年12月期间，共有134例患者（115例男性）在首尔峨山医院接受了针对HCC孤立性肺转移的肺转移瘤切除术。其中，84例接受了VATS（VATS组），50例接受了开胸手术或胸骨切开术（开放组）。两组之间的PSM分析用于根据患者的基线特征进行匹配。
在33.4个月的中位随访期（范围1.8 - 112.0个月）内，113例患者（84.3%）出现复发，100例患者（74.6%）死于疾病进展。VATS组和开放组之间的总生存率、无病生存率和肺特异性无病生存率无差异（p分别为0.521、0.702和0.668）。多因素分析显示，HCC的局部复发、肝硬化病史和术前甲胎蛋白水平是总生存的独立预后因素（风险比分别为1.729/2.495/2.632，95%置信区间为1.142 - 2.619/1.571 - 3.963/1.554 - 4.456；p分别为0.010/<0.001/<0.001）。
对于选定的患者，转移瘤切除术可被视为一种潜在的替代治疗方法。VATS转移瘤切除术的结果与开放转移瘤切除术相当。
