Matsumoto Michinori, Yanaga Katsuhiko, Shiba Hiroaki, Wakiyama Shigeki, Sakamoto Taro, Futagawa Yasuro, Gocho Takeshi, Ishida Yuichi, Ikegami Toru
Department of Surgery The Jikei University School of Medicine Tokyo Japan.
Ann Gastroenterol Surg. 2021 Feb 24;5(4):538-552. doi: 10.1002/ags3.12449. eCollection 2021 Jul.
Prognostic factors after treatment for intrahepatic recurrent hepatocellular carcinoma (RHCC) after hepatic resection (Hx) are controversial. The current study aimed to examine the impact of treatment modality on the prognosis of intrahepatic RHCC following Hx.
For control of variables, the subjects were 56 patients who underwent treatment for intrahepatic RHCC, three or fewer tumors, each measuring ≤3 cm in diameter without macroscopic vascular invasion (MVI), between 2000 and 2011. Retreatment consisted of repeat Hx (n = 23), local ablation therapy (n = 11) and transarterial chemoembolization or transcatheter arterial infusion (TACE/TAI) (n = 22). We retrospectively investigated the relation between type of treatment for RHCC and overall survival (OS) as well as disease-free survival (DFS).
In multivariate (MV) analysis, the poor prognostic factors in DFS after retreatment consisted of disease-free interval (DFI) (≤1.5 y) ( = .011), type of retreatment (TACE/TAI) ( = .002), age (<65 y old) ( = .0022), perioperative RBC transfusion ( = .025), while those in OS after retreatment were DFI (≤1.5 y) ( < .0001). In evaluation of stratification for type of retreatment, DFS in the repeat Hx group was significantly better than those in the local ablation therapy group or the TACE/TAI group ( = .023 or < .0001, respectively).
DFI (≤1.5 y) was an independent poor prognostic factor in both DFS and OS, and repeat Hx for intrahepatic RHCC, few in number and size without MVI, seems to achieve the most reliable local control.
肝切除术后肝内复发性肝细胞癌（RHCC）治疗后的预后因素存在争议。本研究旨在探讨治疗方式对肝切除术后肝内RHCC预后的影响。
为控制变量，研究对象为2000年至2011年间接受肝内RHCC治疗的56例患者，肿瘤数量为3个或更少，每个肿瘤直径≤3 cm，无肉眼可见血管侵犯（MVI）。再次治疗包括重复肝切除（n = 23）、局部消融治疗（n = 11）和经动脉化疗栓塞或经导管动脉灌注（TACE/TAI）（n = 22）。我们回顾性研究了RHCC治疗类型与总生存期（OS）以及无病生存期（DFS）之间的关系。
在多因素（MV）分析中，再次治疗后DFS的不良预后因素包括无病间期（DFI）（≤1.5年）（P = .011）、再次治疗类型（TACE/TAI）（P = .002）、年龄（<65岁）（P = .0022）、围手术期红细胞输血（P = .025），而再次治疗后OS的不良预后因素为DFI（≤1.5年）（P < .0001）。在评估再次治疗类型的分层时，重复肝切除组的DFS明显优于局部消融治疗组或TACE/TAI组（分别为P = .023或P < .0001）。
DFI（≤1.5年）是DFS和OS的独立不良预后因素，对于数量少、体积小且无MVI的肝内RHCC，重复肝切除似乎能实现最可靠的局部控制。
