Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, 20 College Road, 169856, Singapore, Singapore.
Duke-National University of Singapore Medical School, Singapore, Singapore.
J Gastrointest Surg. 2023 Jun;27(6):1106-1112. doi: 10.1007/s11605-023-05592-1. Epub 2023 Mar 1.
Liver transplantation remains the optimal treatment for multifocal hepatocellular carcinoma (HCC). However, due to resource constrains, other therapeutic modalities such as liver resection (LR), are frequently utilized. LR, however, has to be balanced against potential morbidity and mortality along with the risks of early recurrence leading to futile surgery. In this study, we evaluated preoperative factors, including inflammatory indices, in predicting early (< 1 year) recurrence in patients who underwent LR for multifocal HCC.
This was a post hoc analysis of 250 consecutive patients with multifocal HCC who underwent LR.
After exclusion of 10 patients with 30-day/in-hospital mortality, 240 were included of which 134 (55.8%) developed early recurrence. Hepatitis B/C aetiology, 3/ > more hepatic nodules and elevated alpha-fetoprotein (AFP) ≥ 200 ng/ml were significant independent preoperative predictors of early recurrence. The early recurrence rate was 72.1% when 2 out of 3 significant predictive factors were present. The conglomerate of all 3 factors predicted early recurrence of 100% with a statistically significant association between number of predictive factors and early recurrence (p < 0.001).
Better patient selection via the use of preoperative predictive factors of early recurrence such as hepatitis B/C aetiology, ≥ 3 nodules and elevated AFP ≥ 200 ng/ml may assist in identifying patients in whom LR is deemed futile and improve resource allocation.
肝移植仍然是多灶性肝细胞癌（HCC）的最佳治疗方法。然而，由于资源限制，肝切除术（LR）等其他治疗方式经常被采用。然而，LR 必须权衡潜在的发病率和死亡率，以及早期复发导致无效手术的风险。在这项研究中，我们评估了术前因素，包括炎症指标，以预测接受多灶性 HCC 行 LR 治疗的患者的早期（<1 年）复发。
这是对 250 例连续多灶性 HCC 患者行 LR 治疗的回顾性分析。
排除 30 天/住院内死亡的 10 例患者后，共纳入 240 例患者，其中 134 例（55.8%）发生早期复发。乙型肝炎/丙型肝炎病因、3/ > 更多个肝结节和甲胎蛋白（AFP）升高≥200ng/ml是早期复发的独立术前预测因素。当存在 2 个及以上显著预测因素时，早期复发率为 72.1%。所有 3 个因素的组合预测早期复发率为 100%，且预测因素数量与早期复发之间存在统计学显著关联（p<0.001）。
通过使用术前早期复发的预测因素，如乙型肝炎/丙型肝炎病因、≥3 个结节和 AFP 升高≥200ng/ml，更好地选择患者，可能有助于识别 LR 被认为无效的患者，并改善资源分配。
