Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India.
Hepato-Pancreato-Biliary and Transplant Surgery, University Hospital Birmingham and Birmingham Children's Hospital, Birmingham, UK.
Langenbecks Arch Surg. 2023 Apr 12;408(1):144. doi: 10.1007/s00423-023-02881-w.
Hepatocellular carcinoma (HCC) accounts for the sixth most common cancer and ranks third in mortality worldwide with inhomogeneity in terms of resection for advanced-stage disease.
A systematic review of published literature using the PubMed, Medline, and Google Scholar databases from 1995 to 2020 was conducted to identify studies that reported outcomes of resection for solitary HCC > 10 cm, BCLC B/C, and multinodular HCC. Our aim was to assess overall survival for resection, identify poor prognostic factors, and to compare it to trans-arterial chemotherapy (TACE) where data was available.
Eighty-nine articles were included after a complete database search in the systematic review as per our predefined criteria. Analysis revealed a 5-year overall survival of 33.5% for resection of HCC > 10 cm, 41.7% for BCLC B, 23.3% for BCLC C, and 36.6% for multinodular HCC. Peri-operative mortality ranged from 0 to 6.9%. Studies comparing resection versus TACE for BCLC B/C had a survival of 40% versus 17%, respectively.
Our systematic review justifies hepatic resection wherever feasible for hepatocellular carcinomas > 10 cm, BCLC B, BCLC C, and multinodular tumors. In addition, we identified and proposed an algorithm with five poor prognostic criteria in this group of patients who may benefit from adjuvant TACE.
肝细胞癌（HCC）是全球第六大常见癌症，也是全球第三大癌症死亡原因，其在晚期疾病的切除方面存在异质性。
通过对 1995 年至 2020 年期间发表的文献进行 PubMed、Medline 和 Google Scholar 数据库的系统综述，以确定报道了> 10cm 单个 HCC、BCLC B/C 和多结节 HCC 切除术结果的研究。我们的目的是评估切除术的总体生存率，确定不良预后因素，并将其与可获得数据的经动脉化疗栓塞术（TACE）进行比较。
在系统综述中根据我们预先设定的标准，对完整的数据库进行搜索后，有 89 篇文章符合纳入标准。分析显示，> 10cm HCC 切除术的 5 年总体生存率为 33.5%，BCLC B 为 41.7%，BCLC C 为 23.3%，多结节 HCC 为 36.6%。围手术期死亡率范围为 0 至 6.9%。比较 BCLC B/C 患者切除术与 TACE 的研究，生存率分别为 40%和 17%。
我们的系统综述证明了在可行的情况下，对> 10cm、BCLC B、BCLC C 和多结节肿瘤进行肝切除术是合理的。此外，我们在这组患者中确定并提出了一个带有五个不良预后标准的算法，这些患者可能受益于辅助 TACE。
