Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Japan.
Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan.
Langenbecks Arch Surg. 2023 Aug 16;408(1):314. doi: 10.1007/s00423-023-03057-2.
Factors affecting the prognosis of repeat hepatectomy for transplantable hepatocellular carcinoma (HCC) recurrence after hepatectomy remain unclear. We aimed to clarify the prognostic factors for transplantable hepatocellular carcinoma recurrence after hepatectomy.
We included 1758 primary and 486 repeat hepatectomies out of 2244 for HCC performed between 2006 and 2017 using the Hiroshima Study Group for Clinical Oncology and Surgery database. We first compared survival rates of primary and repeat hepatectomy patients. Subsequently, prognostic factors were analyzed in patients who underwent a repeat hepatectomy for transplantable hepatocellular carcinoma recurrence after hepatectomy (defined as age < 70 years at the time of recurrence and recurrent tumor morphology that meets the Milan criteria).
The 5-year overall survival rate (OS) after repeat hepatectomy was 63.2%, while the 5-year recurrence-free survival rate (RFS) was 23.7%. RFS demonstrated significant inferiority in the repeat hepatectomy group than in the primary hepatectomy group; however, OS did not present a notable difference between the two cohorts. In the transplantable recurrence group, mALBI grade 2b, max tumor size > 20 mm, and multiple tumors were independent prognostic risk factors for overall survival. Patients with two or more risk factors had a significantly lower survival rate (only 30.6% at 5 years) compared to those with one or fewer risk factors (81.8% at 5 years).
We identified the risk factors involved in post-hepatectomy survival for patients with transplantable recurrence after hepatectomy. The results are a potential indicator of whether salvage liver transplantation should be considered during repeat hepatectomy.
影响可移植性肝细胞癌（HCC）切除术后复发再行肝切除术患者预后的因素尚不清楚。本研究旨在阐明可移植性 HCC 切除术后复发再行肝切除术患者的预后因素。
我们使用 Hiroshima 临床肿瘤与外科学研究组数据库，纳入了 2006 年至 2017 年间进行的 2244 例 HCC 患者的 1758 例首次肝切除术和 486 例再次肝切除术。我们首先比较了首次肝切除术和再次肝切除术患者的生存率。随后，对接受再次肝切除术治疗可移植性 HCC 切除术后复发的患者（定义为复发时年龄<70 岁且复发性肿瘤形态符合米兰标准）进行了预后因素分析。
再次肝切除术后的 5 年总生存率（OS）为 63.2%，5 年无复发生存率（RFS）为 23.7%。再次肝切除术组的 RFS 明显低于首次肝切除术组，而 OS 两组之间无显著差异。在可移植性复发组中，mALBI 分级 2b、最大肿瘤直径>20mm 和多个肿瘤是总生存的独立预后危险因素。具有两个或更多危险因素的患者的生存率明显降低（5 年时仅为 30.6%），而具有一个或更少危险因素的患者的生存率较高（5 年时为 81.8%）。
我们确定了影响可移植性 HCC 切除术后复发再行肝切除术后患者生存的危险因素。这些结果可能是在再次肝切除时是否应考虑进行挽救性肝移植的潜在指标。
