早期肝外复发是肝癌切除术后生存的关键因素：一项 15 年观察性研究。

Early extrahepatic recurrence as a pivotal factor for survival after hepatocellular carcinoma resection: A 15-year observational study.

机构信息

Department of Gastroenterology and Hepatology, Chonnam National University Hospital and College of Medicine, Gwangju 61469, South Korea.

Department of Gastroenterology and Hepatology, Hwasun Chonnam National University Hospital and College of Medicine, Hwasun 58128, South Korea.

出版信息

World J Gastroenterol. 2022 Sep 28;28(36):5351-5363. doi: 10.3748/wjg.v28.i36.5351.

DOI:10.3748/wjg.v28.i36.5351

PMID:36185633

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9521522/

Abstract

BACKGROUND

Surgical resection is one of the most widely used modalities for the treatment of hepatocellular carcinoma (HCC). Early extrahepatic recurrence (EHR) of HCC after surgical resection is considered to be closely associated with poor prognosis. However, data regarding risk factors and survival outcomes of early EHR after surgical resection remain scarce.

AIM

To investigate the clinical features and risk factors of early EHR and elucidate its association with survival outcomes.

METHODS

From January 2004 to December 2019, we enrolled treatment-naïve patients who were ≥ 18 years and underwent surgical resection for HCC in two tertiary academic centers. After excluding patients with tumor types other than HCC and/or ineligible data, this retrospective study finally included 779 patients. Surgical resection of HCC was performed according to the physicians' decisions and the EHR was diagnosed based on contrast-enhanced computed tomography or magnetic resonance imaging, and pathologic confirmation was performed in selected patients. Multivariate Cox regression analysis was performed to identify the variables associated with EHR.

RESULTS

Early EHR within 2 years after surgery was diagnosed in 9.5% of patients during a median follow-up period of 4.4 years. The recurrence-free survival period was 5.2 mo, and the median time to EHR was 8.8 mo in patients with early EHR. In 52.7% of patients with early EHR, EHR occurred as the first recurrence of HCC after surgical resection. On multivariate analysis, serum albumin < 4.0 g/dL, serum alkaline phosphatase > 100 U/L, surgical margin involvement, venous and/or lymphatic involvement, satellite nodules, tumor necrosis detected by pathology, tumor size ≥ 7 cm, and macrovascular invasion were determined as risk factors associated with early EHR. After sub-categorizing the patients according to the number of risk factors, the rates of both EHR and survival showed a significant correlation with the risk of early EHR. Furthermore, multivariate analysis revealed that early EHR was associated with substantially worse survival outcomes (Hazard ratio, 6.77; 95% confidence interval, 4.81-9.52; 0.001).

CONCLUSION

Early EHR significantly deteriorates the survival of patients with HCC, and our identified risk factors may predict the clinical outcomes and aid in postoperative strategies for improving survival.

摘要

背景

手术切除是治疗肝细胞癌（HCC）最广泛使用的方法之一。HCC 手术后早期肝外复发（EHR）被认为与预后不良密切相关。然而，关于手术切除后 EHR 的危险因素和生存结果的数据仍然很少。

目的

探讨手术切除后 EHR 的临床特征和危险因素，并阐明其与生存结果的关系。

方法

本研究纳入了 2004 年 1 月至 2019 年 12 月在两家三级学术中心接受手术治疗的初治 HCC 患者。排除肿瘤类型非 HCC 患者和/或不符合条件的患者后，本回顾性研究最终纳入了 779 例患者。HCC 的手术切除是根据医生的决定进行的，EHR 是根据增强 CT 或磁共振成像诊断的，并在选定的患者中进行了病理证实。采用多变量 Cox 回归分析确定与 EHR 相关的变量。

结果

中位随访 4.4 年后，9.5%的患者在术后 2 年内诊断出 EHR。无复发生存期为 5.2 个月，EHR 患者的中位 EHR 时间为 8.8 个月。在 52.7%的 EHR 早期患者中，EHR 是 HCC 手术后的首次复发。多变量分析显示，血清白蛋白<4.0g/dL、碱性磷酸酶>100U/L、手术切缘累及、静脉和/或淋巴受累、卫星结节、病理检查发现肿瘤坏死、肿瘤大小≥7cm 和大血管侵犯是与 EHR 相关的危险因素。根据危险因素的数量对患者进行亚分类后，EHR 和生存的发生率与 EHR 的风险呈显著相关。此外，多变量分析显示，EHR 与较差的生存结果显著相关（危险比，6.77；95%置信区间，4.81-9.52；0.001）。