Moazzam Zorays, Alaimo Laura, Endo Yutaka, Lima Henrique A, Shaikh Chanza F, Ratti Francesca, Marques Hugo P, Cauchy François, Lam Vincent, Poultsides George A, Popescu Irinel, Alexandrescu Sorin, Martel Guillaume, Guglielmi Alfredo, Hugh Tom, Aldrighetti Luca, Endo Itaru, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA.
Department of Surgery, University of Verona, Verona, Italy.
Ann Surg Oncol. 2023 Feb;30(2):750-759. doi: 10.1245/s10434-022-12832-2. Epub 2022 Nov 20.
The impact of early versus intermediate hepatocellular carcinoma (HCC) on short-term "optimal" outcomes remains ill-defined. This study sought to define the incidence of textbook oncologic outcomes (TOO), as well as to identify factors associated with TOO among patients with early versus intermediate HCC.
Patients who underwent curative-intent liver resection for HCC (1998-2020) were identified from a multi-institutional database. Textbook oncologic outcome (TOO) was defined as negative surgical margins, no return to the operating room, no extended hospital stay, no severe complications, and no 90-day mortality or readmission. Patients were stratified as early HCC (BCLC 0 or BCLC A/Child-Pugh A) or intermediate HCC (BCLC A/Child-Pugh B or BCLC B). Multivariate logistic regression analysis was used to assess factors associated with TOO.
Among 1383 patients, the overall incidence of TOO was 69.0%. Patients with intermediate HCC were less likely to achieve a TOO (early [71.6 %] vs. intermediate [60.1%]; p < 0.001). On multivariate analysis, factors associated with decreased odds of a TOO were high tumor burden (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.33-1.00), high aspartate transaminase-platelet ratio index (APRI) (OR, 0.46; 95% CI, 0.30-0.70), Charlson Comorbidity Index (CCI) greater than 3 (OR, 0.67; 95% CI, 0.49-0.91), major liver resection (OR, 0.68; 95% CI, 0.52-0.90), and intermediate HCC (OR, 0.68; 95% CI, 0.50-0.93) (all p < 0.05). Notably, although high APRI, CCI greater than 3, and major liver resection contributed to lower odds of a TOO in early HCC, the only factor that adversely impacted TOO in intermediate HCC was high tumor burden.
Patients with intermediate HCC and early HCC patients with liver dysfunction, comorbidities, or an extensive resection were less likely to achieve an "optimal" postoperative outcome.
早期与中期肝细胞癌（HCC）对短期“最佳”结局的影响仍不明确。本研究旨在确定教科书式肿瘤学结局（TOO）的发生率，并识别早期与中期HCC患者中与TOO相关的因素。
从一个多机构数据库中识别出1998年至2020年期间因HCC接受根治性肝切除术的患者。教科书式肿瘤学结局（TOO）定义为手术切缘阴性、未返回手术室、未延长住院时间、无严重并发症以及无90天死亡率或再入院情况。患者被分为早期HCC（BCLC 0期或BCLC A期/Child-Pugh A级）或中期HCC（BCLC A期/Child-Pugh B级或BCLC B期）。采用多因素逻辑回归分析来评估与TOO相关的因素。
在1383例患者中，TOO的总体发生率为69.0%。中期HCC患者实现TOO的可能性较小（早期[71.6%]对中期[60.1%]；p<0.001）。多因素分析显示，与TOO几率降低相关的因素包括肿瘤负荷高（比值比[OR]，0.57；95%置信区间[CI]，0.33 - 1.00）、天冬氨酸转氨酶-血小板比值指数（APRI）高（OR，0.46；95%CI，0.30 - 0.70）、Charlson合并症指数（CCI）大于3（OR，0.67；95%CI，0.49 - 0.91）、大范围肝切除术（OR，0.68；95%CI，0.52 - 0.90）以及中期HCC（OR，0.68；95%CI，0.50 - 0.93）（均p<0.05）。值得注意的是，尽管高APRI、CCI大于3以及大范围肝切除术导致早期HCC患者的TOO几率降低，但在中期HCC中对TOO产生不利影响的唯一因素是肿瘤负荷高。
中期HCC患者以及存在肝功能障碍、合并症或接受大范围切除术的早期HCC患者实现“最佳”术后结局的可能性较小。
