First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan.
World J Surg Oncol. 2022 Mar 22;20(1):90. doi: 10.1186/s12957-022-02563-9.
Generally, a large tumor size of hepatocellular carcinoma (HCC) is associated with poor visibility and uncertainty in the surgical field which results in increased surgical difficulty as well as unfavorable postoperative outcomes. We performed intended preoperative trans-arterial embolization (TAE) in patients with a large HCC. In this study, we investigated the oncological significance of intended preoperative TAE for a large HCC, using a comparison between patients with and without TAE, and detailed analyses for pre- and post-TAE status.
A total of 411 patients who underwent hepatectomy for primary HCC at the University of Yamanashi Hospital between January 2007 and December 2018 were included in this study. The patients were divided into two groups: patients with larger HCCs (≥50 mm, n=51) and those with smaller HCC (<50 mm, n=360) according to the size of their HCCs. Comparison of clinicopathological features between these groups and clinical outcomes between the TAE and non-TAE groups were compared. In addition, a detailed analysis of each case in the TAE group was conducted, comparing clinicopathological factors between pre- and post-TAE status.
The clinical unfavorable short- and long-term outcomes of patients with large HCCs (≥50 mm) were revealed compared to those with small HCCs (<50 mm). The prognostic analyses showed that a large tumor size and increased tumor markers, multiple tumor numbers, and others were adverse prognostic factors, and vascular invasions and residual tumors were included in the multivariate analysis. Further detailed analyses revealed that the average rates of change in tumor size and tumor shrinkage after TAE were - 48.6±35.6 mm and - 30.7±17.0%, respectively. Pathological high necrotic changes in the tumor, after multiple-times TAE aiming to a better effect, were related to a better prognosis in patients with large HCC. Poor prognostic factors became less common in patients who underwent intended preoperative TAE, and these patients had better prognoses.
The large tumor size of HCC is associated with unfavorable outcomes; the intended preoperative TAE for large HCC patients performed multiple times aiming to affect the tumor as much as possible might improve their prognoses.
一般来说，肝癌（HCC）的肿瘤较大与手术视野不佳和不确定性相关，这导致手术难度增加以及术后结果不佳。我们对大肝癌患者进行了术前计划的肝动脉栓塞术（TAE）。在这项研究中，我们通过比较有 TAE 和无 TAE 的患者，以及术前和术后状态的详细分析，研究了大肝癌患者术前计划 TAE 的肿瘤学意义。
本研究共纳入 2007 年 1 月至 2018 年 12 月期间在山梨大学医院接受原发性 HCC 肝切除术的 411 例患者。根据 HCC 大小，将患者分为两组：肿瘤较大组（≥50mm，n=51）和肿瘤较小组（<50mm，n=360）。比较两组的临床病理特征和 TAE 组与非 TAE 组的临床结局。此外，对 TAE 组的每个病例进行详细分析，比较术前和术后的临床病理因素。
与小 HCC 组（<50mm）相比，大 HCC 组（≥50mm）患者的短期和长期临床预后较差。预后分析显示，大肿瘤大小、肿瘤标志物升高、多个肿瘤数目等是不良预后因素，血管侵犯和残留肿瘤被纳入多因素分析。进一步的详细分析显示，TAE 后肿瘤大小的平均变化率和肿瘤缩小率分别为-48.6±35.6mm 和-30.7±17.0%。为了达到更好的效果，多次 TAE 后肿瘤的病理性高坏死变化与大 HCC 患者的更好预后相关。在接受术前计划 TAE 的患者中，预后不良的因素变得不那么常见，这些患者的预后更好。
HCC 的大肿瘤大小与不良预后相关；对大 HCC 患者进行多次术前 TAE 以尽可能影响肿瘤可能改善其预后。
