Pham Anh Duy, Vaz Karl, Ardalan Zaid S, Sinclair Marie, Apostolov Ross, Gardner Sarah, Majeed Ammar, Mishra Gauri, Kam Ning Mao, Patwala Kurvi, Kutaiba Numan, Arachchi Niranjan, Bell Sally, Dev Anouk T, Lubel John S, Nicoll Amanda J, Sood Siddharth, Kemp William, Roberts Stuart K, Fink Michael, Testro Adam G, Angus Peter W, Gow Paul J
The Victorian Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia.
Department of Gastroenterology, Alfred Health, Melbourne 3000, Victoria, Australia.
World J Hepatol. 2021 Oct 27;13(10):1439-1449. doi: 10.4254/wjh.v13.i10.1439.
Management of single small hepatocellular carcinoma (HCC) is straightforward with curative outcomes achieved by locoregional therapy or resection. Liver transplantation is often considered for multiple small or single large HCC. Management of two small HCC whether presenting synchronously or sequentially is less clear.
To define the outcomes of patients presenting with two small HCC.
Retrospective review of HCC databases from multiple institutions of patients with either two synchronous or sequential HCC ≤ 3 cm between January 2000 and March 2018. Primary outcomes were overall survival (OS) and transplant-free survival (TFS).
104 patients were identified (male = 89). Median age was 63 years (interquartile range 58-67.75) and the most common aetiology of liver disease was hepatitis C (40.4%). 59 (56.7%) had synchronous HCC and 45 (43.3%) had sequential. 36 patients died (34.6%) and 25 were transplanted (24.0%). 1, 3 and 5-year OS was 93.0%, 66.1% and 62.3% and 5-year post-transplant survival was 95.8%. 1, 3 and 5-year TFS was 82.1%, 45.85% and 37.8%. When synchronous and sequential groups were compared, OS (1,3 and 5 year synchronous 91.3%, 63.8%, 61.1%, sequential 95.3%, 69.5%, 64.6%, 0.41) was similar but TFS was higher in the sequential group (1,3 and 5 year synchronous 68.5%, 37.3% and 29.7%, sequential 93.2%, 56.6%, 48.5%, 0.02) though this difference did not remain during multivariate analysis.
TFS in patients presenting with two HCC ≤ 3 cm is poor regardless of the timing of the second tumor. All patients presenting with two small HCC should be considered for transplantation.
对于单个小肝细胞癌（HCC），通过局部区域治疗或切除可实现治愈，治疗方法简单明了。对于多个小HCC或单个大HCC，通常会考虑肝移植。对于两个小HCC，无论是同时出现还是先后出现，其治疗方法尚不清楚。
明确两个小HCC患者的治疗结果。
回顾性分析2000年1月至2018年3月期间多个机构的HCC数据库中两个同时性或先后性HCC≤3 cm的患者。主要结局指标为总生存期（OS）和无移植生存期（TFS）。
共纳入104例患者（男性89例）。中位年龄为63岁（四分位间距58 - 67.75），最常见的肝病病因是丙型肝炎（40.4%）。59例（56.7%）为同时性HCC，45例（43.3%）为先后性HCC。36例患者死亡（34.6%），25例接受了移植（24.0%）。1年、3年和5年的OS分别为93.0%、66.1%和62.3%，移植后5年生存率为95.8%。1年、3年和5年的TFS分别为82.1%、45.85%和37.8%。比较同时性和先后性两组时，OS相似（1年、3年和5年同时性分别为91.3%、63.8%、61.1%，先后性分别为95.3%、69.5%、64.6%，P = 0.41），但先后性组的TFS更高（1年、3年和5年同时性分别为68.5%、37.3%和29.7%，先后性分别为93.2%、56.6%、48.5%，P = 0.02），不过在多因素分析中这种差异不再存在。
无论第二个肿瘤出现的时间如何，两个HCC≤3 cm患者的TFS都较差。所有两个小HCC患者都应考虑进行移植。
