依据“7-11”标准行手术切除以优化米兰标准以外的巴塞罗那临床肝癌分期A/B期肝细胞癌的生存获益
Optimizing Survival Benefit by Surgical Resection by the Seven-Eleven Criteria in Barcelona Clinic Liver Cancer Stage A/B Hepatocellular Carcinoma beyond the Milan Criteria.
作者信息
Huang Chian-Tzu, Chu Yu-Long, Su Tung-Hung, Huang Shang-Chin, Tseng Tai-Chung, Hsu Shih-Jer, Liao Sih-Han, Hong Chun-Ming, Liu Chen-Hua, Yang Hung-Chih, Liu Chun-Jen, Chen Pei-Jer, Kao Jia-Horng
机构信息
School of Medicine, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Good Liver Clinic, Taipei, Taiwan.
出版信息
Liver Cancer. 2023 Jan 19;12(6):539-549. doi: 10.1159/000529143. eCollection 2023 Dec.
INTRODUCTION
Optimal treatment of hepatocellular carcinoma (HCC) beyond the Milan criteria is in debate. We aimed to identify candidates for surgical resection (SR) in Barcelona Clinic Liver Cancer (BCLC)-A/B HCC beyond the Milan criteria with survival benefit.
METHODS
Patients with BCLC-A/B HCC beyond the Milan criteria at the National Taiwan University Hospital during 2005 and 2019 were screened, and those who received transarterial chemoembolization (TACE) or SR were consecutively included. The tumor burden was classified by the seven-eleven criteria into low (≤7), intermediate (7-11), or high (>11). Multivariable Cox proportional hazard regression analysis was used for outcome prediction.
RESULTS
Overall, 474 patients who received SR ( = 247) and TACE ( = 227) were enrolled. Patients who underwent SR were significantly younger with better liver reserve. There were 76 (31%) and 129 (57%) deaths in the SR and TACE groups after a median follow-up of 3.9 and 2.1 years, respectively. The seven-eleven criteria could distinguish median overall survival (OS) among low ( = 149), intermediate ( = 203), and high ( = 122) tumor burden groups (7.7 vs. 6.9 vs. 2.8 years, respectively, < 0.001). Patients receiving SR had a significantly higher median OS compared with TACE in those with intermediate (8.2 vs. 2.6 years, < 0.001) and high (5.6 vs. 1.5 years, = 0.001) tumor burden. After adjustment for age, sex, and liver reserve, SR was predictive for better OS in intermediate (adjusted hazard ratio [aHR]: 0.45, 95% confidence interval [CI]: 0.27-0.75) and high tumor burden groups (aHR: 0.54, 95% CI: 0.32-0.92). The survival benefit of SR especially confines to patients within 3 tumors.
CONCLUSIONS
In patients with BCLC-A/B HCC beyond the Milan criteria with tumor burden beyond the up-to-7 criteria but within 3 tumors, SR has better OS than TACE and should be considered in resectable patients.
引言
对于超出米兰标准的肝细胞癌（HCC）的最佳治疗方法仍存在争议。我们旨在确定超出米兰标准的巴塞罗那临床肝癌（BCLC）-A/B期HCC患者中能从手术切除（SR）中获益并生存的候选者。
方法
筛选2005年至2019年期间在台湾大学医院诊断为超出米兰标准的BCLC-A/B期HCC患者，连续纳入接受经动脉化疗栓塞术（TACE）或SR的患者。根据7-11标准将肿瘤负荷分为低（≤7）、中（7-11）或高（>11）。采用多变量Cox比例风险回归分析进行预后预测。
结果
总体而言，共纳入474例接受SR（n = 247）和TACE（n = 227）的患者。接受SR的患者明显更年轻，肝脏储备功能更好。SR组和TACE组分别在中位随访3.9年和2.1年后，死亡人数分别为76例（31%）和129例（57%）。7-11标准可以区分低肿瘤负荷组（n = 149）、中肿瘤负荷组（n = 203）和高肿瘤负荷组（n = 122）的中位总生存期（OS）（分别为7.7年、6.9年和2.8年，P < 0.001）。在中肿瘤负荷（8.2年对2.6年，P < 0.001）和高肿瘤负荷（5.6年对1.5年，P = 0.001）的患者中，接受SR的患者中位OS显著高于TACE组。在调整年龄、性别和肝脏储备后，SR对中肿瘤负荷组（调整后风险比[aHR]：0.45，95%置信区间[CI]：0.27-0.75）和高肿瘤负荷组（aHR：0.54，95% CI：0.32-0.92）的更好OS具有预测性。SR的生存获益尤其局限于3个肿瘤以内的患者。
结论
对于超出米兰标准、肿瘤负荷超出7个标准但在3个肿瘤以内的BCLC-A/B期HCC患者，SR的OS优于TACE，对于可切除的患者应考虑采用SR。
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