Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Ann Surg Oncol. 2022 Dec;29(13):8436-8445. doi: 10.1245/s10434-022-12495-z. Epub 2022 Sep 13.
A single hepatocellular carcinoma (HCC) is a good indication for hepatic resection regardless of tumor size, but the surgical indications for cases with multiple HCCs remain unclear.
We retrospectively reviewed the outcomes of hepatectomies for Barcelona Clinic Liver Cancer (BCLC) stage 0, A, and B HCCs. We further subclassified stage A and B into A1 (single nodule <5 cm, or three or fewer nodules ≤3 cm), A2 (single nodule 5-10 cm), A3 (single nodule ≥10 cm), B1 (two to three nodules >3 cm), and B2 (four or more nodules).
A total of 1088 patients were enrolled, comprising 88 stage 0, 750 stage A (A1: 485; A2: 190; A3: 75), and 250 stage B (B1: 166; B2: 84) cases. The 5-year overall survival (OS) rates for stage 0, A1, A2, A3, B1, and B2 patients were 70.4%, 74.2%, 63.8%, 47.7%, 47.5%, and 31.9%, respectively (p < 0.0001). Significant differences in OS were found between stages A1 and A2 (p = 0.0118), A2 and A3 (p = 0.0013), and B1 and B2 (p = 0.0050), but not between stages A3 and B1 (p = 0.4742). In stage B1 patients, multivariate analysis indicated that Child-Pugh B cirrhosis was the only independent prognostic factor for the OS outcome.
A hepatectomy should be considered for multiple HCCs if the number of tumors is three or fewer, especially in patients with no cirrhosis or in Child-Pugh A cases, because the long-term results are equivalent to those for a single HCC.
单个肝细胞癌（HCC）是肝切除术的良好适应证，无论肿瘤大小如何，但对于多个 HCC 的手术适应证仍不清楚。
我们回顾性分析了巴塞罗那临床肝癌（BCLC）分期 0、A 和 B 的 HCC 患者的肝切除术结果。我们进一步将 A 期和 B 期细分为 A1（单个结节 <5cm，或三个或更少结节 ≤3cm）、A2（单个结节 5-10cm）、A3（单个结节 ≥10cm）、B1（两个至三个结节 >3cm）和 B2（四个或更多结节）。
共纳入 1088 例患者，包括 88 例 0 期、750 例 A 期（A1：485 例；A2：190 例；A3：75 例）和 250 例 B 期（B1：166 例；B2：84 例）。0 期、A1、A2、A3、B1 和 B2 患者的 5 年总生存率（OS）分别为 70.4%、74.2%、63.8%、47.7%、47.5%和 31.9%（p<0.0001）。A1 期和 A2 期（p=0.0118）、A2 期和 A3 期（p=0.0013）以及 B1 期和 B2 期（p=0.0050）之间的 OS 差异有统计学意义，但 A3 期和 B1 期之间的差异无统计学意义（p=0.4742）。在 B1 期患者中，多因素分析表明，Child-Pugh B 级肝硬化是 OS 结果的唯一独立预后因素。
如果肿瘤数量为三个或更少，应考虑对多个 HCC 进行肝切除术，特别是对于没有肝硬化或 Child-Pugh A 级的患者，因为长期结果与单个 HCC 相当。
