Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Surgery, University of Verona, Verona, Italy.
World J Surg. 2021 Nov;45(11):3438-3448. doi: 10.1007/s00268-021-06265-3. Epub 2021 Aug 2.
The impact of tumor burden score (TBS) on conditional survival (CS) among patients undergoing curative-intent resection of hepatocellular carcinoma (HCC) has not been examined to date.
Patients who underwent liver resection of HCC between 2000 and 2017 were identified from a multi-institutional database. The impact of TBS and other clinicopathologic factors on 3-year conditional survival (CS) was examined.
Among 1,040 patients, 263 (25.3%) patients had low TBS, 668 (64.2%) had medium TBS and 109 (10.5%) had high TBS. TBS was strongly associated with OS; 5-year OS was 39.0% among patients with high TBS compared with 61.1% and 79.4% among patients with medium and low TBS, respectively (p < 0.001). While actuarial survival decreased as time elapsed from resection, CS increased over time irrespective of TBS. The largest differences between 3-year actuarial survival and CS were noted among patients with high TBS (5-years postoperatively; CS: 78.7% vs. 3-year actuarial survival: 30.7%). The effect of adverse clinicopathologic factors including high TBS, poor/undifferentiated tumor grade, microvascular invasion, liver capsule involvement, and positive margins on prognosis decreased over time.
CS rates among patients who underwent resection for HCC increased as patients survived additional years, irrespective of TBS. CS estimates can be used to provide important dynamic information relative to the changing survival probability after resection of HCC.
目前尚未研究肿瘤负担评分（TBS）对接受根治性切除肝癌（HCC）患者的条件生存（CS）的影响。
从一个多机构数据库中确定了 2000 年至 2017 年间接受 HCC 肝切除术的患者。检查了 TBS 和其他临床病理因素对 3 年条件生存（CS）的影响。
在 1040 例患者中，263 例（25.3%）患者的 TBS 较低，668 例（64.2%）患者的 TBS 中等，109 例（10.5%）患者的 TBS 较高。TBS 与 OS 密切相关；高 TBS 患者的 5 年 OS 为 39.0%，而中、低 TBS 患者的 5 年 OS 分别为 61.1%和 79.4%（p<0.001）。虽然随着切除后时间的推移，实际生存率下降，但无论 TBS 如何，CS 都会随着时间的推移而增加。在 TBS 较高的患者中，3 年实际生存率和 CS 之间的差异最大（术后 5 年；CS：78.7%比 3 年实际生存率：30.7%）。包括 TBS 高、肿瘤分级差/未分化、微血管侵犯、肝包膜受累和切缘阳性等不良临床病理因素对预后的影响随着时间的推移而降低。
无论 TBS 如何，接受 HCC 切除术的患者的 CS 率随着患者存活时间的延长而增加。CS 估计值可用于提供与 HCC 切除后生存概率变化相关的重要动态信息。
