Maulat Charlotte, Truant Stéphanie, Hobeika Christian, Barbier Louise, Herrero Astrid, Doussot Alexandre, Gagnière Johan, Girard Édouard, Tranchart Hadrien, Regimbeau Jean-Marc, Fuks David, Cauchy François, Prodeau Mathieu, Notte Antoine, Toubert Cyprien, Salamé Ephrem, El Amrani Mehdi, Andrieu Sandrine, Muscari Fabrice, Shourick Jason, Suc Bertrand
Department of Digestive Surgery, Hepatobiliary and Pancreatic Surgery and Liver Transplantation Unit, Toulouse University Hospital, Toulouse, France.
Department of Digestive Surgery and Transplantation, Claude-Huriez, Hospital, CHRU Lille, Lille, France.
Hepatobiliary Surg Nutr. 2023 Apr 10;12(2):192-204. doi: 10.21037/hbsn-22-33. Epub 2022 Sep 22.
Liver resection and local ablation are the only curative treatment for non-cirrhotic hepatocellular carcinoma (HCC). Few data exist concerning the prognosis of patients resected for non-cirrhotic HCC. The objectives of this study were to determine the prognostic factors of recurrence-free survival (RFS) and overall survival (OS) and to develop a prognostication algorithm for non-cirrhotic HCC.
French multicenter retrospective study including HCC patients with non-cirrhotic liver without underlying viral hepatitis: F0, F1 or F2 fibrosis.
A total of 467 patients were included in 11 centers from 2010 to 2018. Non-cirrhotic liver had a fibrosis score of F0 (n=237, 50.7%), F1 (n=127, 27.2%) or F2 (n=103, 22.1%). OS and RFS at 5 years were 59.2% and 34.5%, respectively. In multivariate analysis, microvascular invasion and HCC differentiation were prognostic factors of OS and RFS and the number and size were prognostic factors of RFS (P<0.005). Stratification based on RFS provided an algorithm based on size (P=0.013) and number (P<0.001): 2 HCC with the largest nodule ≤10 cm (n=271, Group 1); 2 HCC with a nodule >10 cm (n=176, Group 2); >2 HCC regardless of size (n=20, Group 3). The 5-year RFS rates were 52.7% (Group 1), 30.1% (Group 2) and 5% (Group 3).
We developed a prognostication algorithm based on the number (≤ or >2) and size (≤ or >10 cm), which could be used as a treatment decision support concerning the need for perioperative therapy. In case of bifocal HCC, surgery should not be a contraindication.
肝切除术和局部消融是治疗非肝硬化肝细胞癌（HCC）的唯一根治性方法。关于非肝硬化HCC患者肝切除术后的预后数据较少。本研究的目的是确定无复发生存期（RFS）和总生存期（OS）的预后因素，并开发一种非肝硬化HCC的预后评估算法。
一项法国多中心回顾性研究，纳入无潜在病毒性肝炎的非肝硬化肝脏的HCC患者：F0、F1或F2纤维化。
2010年至2018年，11个中心共纳入467例患者。非肝硬化肝脏的纤维化评分为F0（n = 237，50.7%）、F1（n = 127，27.2%）或F2（n = 103，22.1%）。5年总生存率和无复发生存率分别为59.2%和34.5%。多因素分析显示，微血管侵犯和HCC分化是总生存期和无复发生存期的预后因素，肿瘤数量和大小是无复发生存期的预后因素（P < 0.005）。根据无复发生存期进行分层，得出一种基于肿瘤大小（P = 0.013）和数量（P < 0.001）的算法：最大结节≤10 cm的2个HCC（n = 271，第1组）；有一个结节>10 cm的2个HCC（n = 176，第2组）；>2个HCC（无论大小）（n = 20，第3组）。5年无复发生存率分别为52.7%（第1组）、30.1%（第2组）和5%（第3组）。
我们开发了一种基于肿瘤数量（≤或>2个）和大小（≤或>10 cm）的预后评估算法，可用于支持关于围手术期治疗必要性的治疗决策。对于双灶性HCC，手术不应成为禁忌。
