解剖性切除术对 T1-T2 期或微小血管侵犯的肝细胞癌患者长期生存的影响。

Impact of anatomic resection on long-term survival in patients with hepatocellular carcinoma with T1-T2 disease or microscopic vascular invasion.

机构信息

Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.

出版信息

Surg Oncol. 2023 Aug;49:101951. doi: 10.1016/j.suronc.2023.101951. Epub 2023 May 18.

DOI:10.1016/j.suronc.2023.101951

PMID:37236136

Abstract

BACKGROUND

This study aimed to clarify potential candidates for anatomic resection (AR) among patients with pathological T1-T2 (pT1-T2) hepatocellular carcinoma (HCC) and to determine whether AR is effective for HCC with microscopic vascular invasion (MVI).

METHODS

We retrospectively analyzed 288 patients with pT1a (n = 50), pT1b (n = 134) or pT2 (n = 104) HCC who underwent curative-intent resection between 1990 and 2010. Surgical outcomes were compared between patients who underwent AR (n = 189) and those who underwent nonanatomic resection (NAR; n = 99) according to pT category and MVI status.

RESULTS

Patients who underwent AR were more likely to have good hepatic functional reserve and an aggressive primary tumor than those who underwent NAR. When patients were stratiﬁed according to pT category, AR had a more favorable impact on survival than NAR only in patients with pT2 HCC in univariate (5-year survival, 51.5% vs. 34.6%; p = 0.010) and multivariate analysis (hazard ratio 0.505; p = 0.014). However, AR had no impact on survival in patients with pT1a or pT1b HCC. In patients with MVI (n = 57), AR achieved better survival than NAR (5-year survival, 52.0% vs. 16.7%; p = 0.019) and was an independent prognostic factor (hazard ratio 0.335; p = 0.020). In patients without MVI (n = 231), there was no significant difference in survival between the two groups (p = 0.221).

CONCLUSION

AR was identified as an independent factor in improved survival in patients with pT2 HCC or HCC with MVI.

摘要

背景

本研究旨在明确病理 T1-T2（pT1-T2）肝细胞癌（HCC）患者行解剖性切除术（AR）的潜在候选人群，并确定 AR 是否对伴有微血管侵犯（MVI）的 HCC 有效。

方法

我们回顾性分析了 1990 年至 2010 年间接受根治性切除术的 288 例 pT1a（n=50）、pT1b（n=134）或 pT2（n=104）HCC 患者。根据 pT 分期和 MVI 状态，比较接受 AR（n=189）和非解剖性切除术（NAR；n=99）的患者的手术结果。

结果

与 NAR 相比，接受 AR 的患者更有可能具有良好的肝储备功能和侵袭性的原发性肿瘤。当根据 pT 分期对患者进行分层时，在单因素（5 年生存率，51.5% vs. 34.6%；p=0.010）和多因素分析（风险比 0.505；p=0.014）中，AR 对生存的影响均优于 NAR。然而，在 pT1a 或 pT1b HCC 患者中，AR 对生存无影响。在有 MVI（n=57）的患者中，AR 的生存情况优于 NAR（5 年生存率，52.0% vs. 16.7%；p=0.019），并且是独立的预后因素（风险比 0.335；p=0.020）。在无 MVI（n=231）的患者中，两组之间的生存无显著差异（p=0.221）。