Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China; Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, China; Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, China.
Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China.
Surgery. 2022 Oct;172(4):1147-1155. doi: 10.1016/j.surg.2022.05.023. Epub 2022 Jul 19.
Data on recurrence are important to inform surveillance and improve long-term surgical outcomes for patients with hepatocellular carcinoma. We sought to identify risk factors and long-term prognosis among patients who experienced beyond-Milan recurrence after hepatectomy for early-stage hepatocellular carcinoma.
Patients who underwent hepatectomy for Barcelona Clinic Liver Cancer stage 0/A hepatocellular carcinoma were identified from a multi-institutional database. Predictors of beyond-Milan recurrence and risk factors associated with post-recurrence survival among patients with beyond-Milan recurrence were assessed using univariate and multivariate Cox regression analyses.
Among 753 patients (median follow-up, 51.8 months), 138 (18.3%) developed beyond-Milan recurrence. Regular surveillance (interval follow-up ≤3 months within 1 year and ≤6 months in subsequent years after surgery) was not carried out for 53 (38.4%) patients who developed beyond-Milan recurrence. On multivariate analysis, increased risk of beyond-Milan recurrence was independently associated with preoperative alpha-fetoprotein level >400 ng/mL, tumor size >5.0 cm, multifocal disease, microvascular invasion, and no/irregular recurrence surveillance. Median post-recurrence survival among patients with beyond-Milan recurrence was only 8.4 months (95% confidence interval: 7.0-9.8 months). Among patients who developed beyond-Milan recurrence, Child-Pugh grade B/C, early recurrence within 1 year after surgery, macrovascular invasion/distant metastasis, and noncurative treatment of recurrence were independent risk factors associated with worse post-recurrence survival.
Nearly 1 in 5 patients developed beyond-Milan recurrence after hepatectomy for early-stage hepatocellular carcinoma. Patients with beyond-Milan recurrence had a median survival of less than 1 year after diagnosis of the recurrence. Regular surveillance is an important and actionable measure to decrease beyond-Milan recurrence and, in turn, improve long-term survival among patients treated with hepatectomy for hepatocellular carcinoma.
复发数据对于告知监测和改善早期肝细胞癌患者的长期手术结果非常重要。我们旨在确定米兰标准以外复发患者的风险因素和长期预后。
从多机构数据库中确定巴塞罗那临床肝癌分期 0/A 期肝细胞癌接受肝切除术的患者。使用单变量和多变量 Cox 回归分析评估米兰标准以外复发的预测因素以及米兰标准以外复发患者与复发后生存相关的风险因素。
在 753 例患者（中位随访时间为 51.8 个月）中，138 例（18.3%）发生了米兰标准以外的复发。53 例（38.4%）发生米兰标准以外复发的患者未进行定期监测（术后 1 年内随访间隔≤3 个月，术后后续年份≤6 个月）。多变量分析显示，术前甲胎蛋白水平>400ng/ml、肿瘤直径>5.0cm、多发病灶、微血管侵犯和无/不规则复发监测与米兰标准以外复发的高风险独立相关。米兰标准以外复发患者的中位复发后生存时间仅为 8.4 个月（95%置信区间：7.0-9.8 个月）。在发生米兰标准以外复发的患者中，Child-Pugh 分级 B/C、术后 1 年内早期复发、大血管侵犯/远处转移以及复发的非治愈性治疗是与复发后生存较差相关的独立危险因素。
近 1/5 的接受早期肝细胞癌肝切除术的患者发生了米兰标准以外的复发。米兰标准以外复发患者在诊断复发后中位生存时间不足 1 年。定期监测是减少米兰标准以外复发并进而改善肝细胞癌肝切除术后患者长期生存的重要且可行的措施。
