Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
National Center for Global Health and Medicine, Tokyo, Japan.
Surgery. 2022 Oct;172(4):1174-1178. doi: 10.1016/j.surg.2022.06.019. Epub 2022 Aug 5.
According to the American Association for the Study of Liver Diseases guidelines, liver resection is not recommended for multiple hepatocellular carcinomas, although it is performed in Asian countries, including Japan. However, the maximum number, location, and recurrence types of tumors have not been reported in detail.
This retrospective study analyzed data for 1,170 patients who underwent surgical resection for hepatocellular carcinoma between October 2002 and December 2020 in a Japanese tertiary care hospital. Statistical analysis was performed to compare the surgical short-term and long-term outcomes among patients with >3 tumors and those with ≤3 tumors.
This study of patients who underwent liver resection identified 775 who had a single tumor and compared overall survival rates with 477 who had multiple hepatocellular carcinomas: 242 had 2 hepatocellular carcinomas, 79 had 3 hepatocellular carcinomas, and 74 had >3 hepatocellular carcinomas. The median survival times based on the number of tumors were 9.74 years for a single tumor, 6.36 years for 2 tumors, 7.21 years for 3 tumors, 3.31 years for 4 tumors, and 3.48 years for 5 tumors. The median survival time was significantly worse in patients with >3 tumors than in those with 3 tumors (P < .0001). Concerning the type of treatments for recurrence, the patients who underwent surgical treatment had significantly better survival after recurrence than patients who underwent other treatments (8.32 vs 3.19 years; P < .001).
The overall survival after liver resection was significantly worse for patients with >3 tumors than for those with <3 tumors. However, liver resection can be recommended for patients with 2 or 3 hepatocellular carcinomas because an acceptable median survival (>5 years) can be expected.
根据美国肝病研究协会的指南，不建议对多个肝细胞癌进行肝切除术，尽管包括日本在内的亚洲国家仍在施行这种手术。然而，肿瘤的最大数量、位置和复发类型尚未详细报道。
本回顾性研究分析了 2002 年 10 月至 2020 年 12 月在日本一家三级护理医院接受肝切除术的 1170 例肝细胞癌患者的数据。对肿瘤>3 个和肿瘤≤3 个的患者的手术短期和长期结果进行了统计学分析。
这项对接受肝切除术的患者的研究确定了 775 例单个肿瘤患者，并将总体生存率与 477 例多个肝细胞癌患者进行了比较：242 例有 2 个肝细胞癌，79 例有 3 个肝细胞癌，74 例有>3 个肝细胞癌。根据肿瘤数量的中位数生存时间分别为单个肿瘤 9.74 年、2 个肿瘤 6.36 年、3 个肿瘤 7.21 年、4 个肿瘤 3.31 年和 5 个肿瘤 3.48 年。肿瘤>3 个的患者中位生存时间明显差于肿瘤 3 个的患者（P<0.0001）。关于复发性治疗类型，接受手术治疗的患者在复发后生存明显优于接受其他治疗的患者（8.32 年比 3.19 年；P<0.001）。
与肿瘤<3 个的患者相比，肿瘤>3 个的患者肝切除术后的总体生存率明显较差。然而，对于 2 个或 3 个肝细胞癌患者，肝切除术可以被推荐，因为可以预期一个可接受的中位生存时间（>5 年）。
