肝癌切除术中区域淋巴结采样：对预后的洞察

Regional lymph node sampling in hepatoma resection: insight into prognosis.

作者信息

Bergquist John R, Li Amy Y, Javadi Christopher S, Lee Byrne, Norton Jeffrey A, Poultsides George A, Dua Monica M, Visser Brendan C

机构信息

Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Stanford University, Stanford, CA, USA.

Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Stanford University, Stanford, CA, USA; Department of Surgery, General Surgery Residency Program - Henry Ford Hospital, Detroit, MI, USA.

出版信息

HPB (Oxford). 2021 Sep;23(9):1360-1370. doi: 10.1016/j.hpb.2021.01.006. Epub 2021 Jan 15.

DOI:10.1016/j.hpb.2021.01.006

PMID:33563547

Abstract

BACKGROUND

The importance of regional lymph node sampling (LNS) during resection of hepatocellular carcinoma (HCC) is poorly understood. This study sought to ameliorate this knowledge gap through a nationwide population-based analysis.

METHODS

Patients who underwent liver resection (LR) for HCC were identified from Surveillance, Epidemiology and End Results (SEER-18) database (2003-2015). Cohort-based clinicopathologic comparisons were made based on completion of regional LNS. Propensity-score matching reduced bias. Overall and disease-specific survival (OS/DSS) were analyzed.

RESULTS

Among 5395 patients, 835 (15.4%) underwent regional LNS. Patients undergoing LNS had larger tumors (7.0vs4.8 cm) and higher T-stage (30.9 vs. 17.6% T3+, both p < 0.001). Node-positive rate was 12.0%. Median OS (50 months for both) and DSS (28 vs. 29 months) were similar between cohorts, but node-positive patients had decreased OS/DSS (20/16 months, p < 0.01). Matched patients undergoing LNS had equivalent OS (46 vs. 43 months, p = 0.869) and DSS (27 vs. 29 months, p = 0.306) to non-LNS patients. The prognostic impact of node positivity persisted after matching (OS/DSS 24/19 months, p < 0.01). Overall disease-specific mortality were both independently elevated (overall HR 1.71-unmatched, 1.56-matched, p < 0.01; disease-specific HR 1.40-unmatched, p < 0.01, 1.25-matched, p = 0.09).

CONCLUSION

Regional LNS is seldom performed during resection for HCC, but it provides useful prognostic information. As the era of adjuvant therapy for HCC begins, surgeons should increasingly consider performing regional LNS to facilitate optimal multidisciplinary management.

摘要

背景

肝细胞癌（HCC）切除术中区域淋巴结采样（LNS）的重要性尚未得到充分理解。本研究旨在通过一项基于全国人群的分析来弥补这一知识空白。

方法

从监测、流行病学和最终结果（SEER - 18）数据库（2003 - 2015年）中识别出接受肝癌肝切除术（LR）的患者。基于区域LNS的完成情况进行队列基础上的临床病理比较。倾向评分匹配减少了偏差。分析总生存期和疾病特异性生存期（OS/DSS）。

结果

在5395例患者中，835例（15.4%）接受了区域LNS。接受LNS的患者肿瘤更大（7.0对4.8 cm）且T分期更高（T3 + 分别为30.9%对17.6%，两者p < 0.001）。淋巴结阳性率为12.0%。队列之间的中位OS（两者均为50个月）和DSS（28对29个月）相似，但淋巴结阳性患者的OS/DSS降低（20/16个月，p < 0.01）。接受LNS的匹配患者与未接受LNS的患者OS（46对43个月，p = 0.869）和DSS（27对29个月，p = 0.306）相当。匹配后淋巴结阳性的预后影响仍然存在（OS/DSS 24/19个月，p < 0.01）。总体疾病特异性死亡率均独立升高（总体HR 1.71 - 未匹配，1.56 - 匹配，p < 0.01；疾病特异性HR 1.40 - 未匹配，p < 0.01，1.25 - 匹配，p = 0.09）。