Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Hepatic Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
ANZ J Surg. 2021 Jun;91(6):1174-1179. doi: 10.1111/ans.16737. Epub 2021 Mar 16.
Extrahepatic recurrence remains a major obstacle to an improved prognosis in patients with hepatocellular carcinoma (HCC) undergoing hepatectomy.
From January 2001 to December 2014, we screened 1330 consecutive patients who underwent curative hepatectomy for HCC. Patients who experienced recurrence were enrolled in this study and divided into an extrahepatic recurrence (EHR) group and a pure intrahepatic recurrence (IHR) group. Clinical data and follow-up results were retrospectively collected and analysed.
A total of 556 patients were enrolled (EHR, 52; IHR, 504). In the EHR group, the lung was the most common site of extrahepatic recurrence (53.8%), among which 67.3% had associated intrahepatic lesions. Background Hepatitis B (HR 0.282; 95% CI 0.106-0.752; P = 0.011), tumour size ≥10 cm at initial diagnosis (HR 2.679; 95% CI 1.283-5.596; P = 0.009) and blood transfusion during initial surgery (HR 2.218; 95% CI 1.132-4.346; P = 0.020) were predictive of EHR. A multidisciplinary team treated recurrent HCC. After a median follow-up period of 46 months (range, 24-192 months), the 1-, 3- and 5-year overall survival rates in the EHR group were 60.7%, 8.9% and 0%, respectively, after recurrence, and 78.8%, 30.2% and 8.9%, respectively, after initial surgery, which were much lower than those in the IHR group.
Tumour size ≥10 cm and blood transfusion during initial surgery were predictive of extrahepatic recurrence in patients with post-hepatectomy recurrent HCC. Treatment options were limited, and long-term survival was unsatisfactory.
肝癌（HCC）患者行肝切除术后，肝外复发仍是改善预后的主要障碍。
从 2001 年 1 月至 2014 年 12 月，我们筛选了 1330 例接受根治性肝切除术的 HCC 连续患者。将复发患者纳入本研究，并分为肝外复发（EHR）组和单纯肝内复发（IHR）组。回顾性收集并分析临床资料和随访结果。
共纳入 556 例患者（EHR 组 52 例，IHR 组 504 例）。EHR 组中，肺是最常见的肝外复发部位（53.8%），其中 67.3%伴有肝内病变。背景性乙型肝炎（HR 0.282；95%CI 0.106-0.752；P=0.011）、初始诊断时肿瘤直径≥10cm（HR 2.679；95%CI 1.283-5.596；P=0.009）和初始手术时输血（HR 2.218；95%CI 1.132-4.346；P=0.020）是 EHR 的预测因素。多学科团队治疗复发性 HCC。中位随访时间为 46 个月（范围：24-192 个月）后，EHR 组复发后 1、3 和 5 年总生存率分别为 60.7%、8.9%和 0%，初始手术后分别为 78.8%、30.2%和 8.9%，均明显低于 IHR 组。
肿瘤直径≥10cm 和初始手术时输血是预测 HCC 患者肝切除术后肝外复发的因素。治疗选择有限，长期生存并不理想。
