Yasukawa Koya, Shimizu Akira, Kubota Koji, Notake Tsuyoshi, Hosoda Kiyotaka, Hayashi Hikaru, Soejima Yuji
Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Liver Cancer. 2023 Oct 31;13(2):150-160. doi: 10.1159/000533857. eCollection 2024 Apr.
Cirrhosis is deemed to be a contributing factor to the postoperative recurrence of hepatocellular carcinoma (HCC); however, the precise impact of liver fibrosis on both cancer-specific prognoses remains unclear. This investigation sought to elucidate the effect of liver fibrosis severity on the cancer-specific prognosis.
A total of 524 consecutive patients were included. Recurrence-free survival (RFS) and disease-specific survival (DSS) were compared according to fibrosis stage. Moreover, postoperative outcomes were subjected to analysis in cohorts of patients with F0 and F1-3, as well as in those with F1-3 and F4, who were carefully matched for background factors.
The 5-year RFS exhibited a significantly worse outcome in the F4 group compared to other stages of fibrosis: 5-year RFS - F0 (46.6%), F1-3 (33.1%), and F4 (23.5%), = 0.03 (F0 vs. F1-3) and < 0.01 (F1-3 vs. F4). Additionally, the 5-year DSS also presented a significantly worse prognosis in the F4 group: 5-year DSS - F0 (82.9%), F1-3 (73.6%), and F4 (57.4%), = 0.04 (F0 vs. F1-3) and < 0.01 (F1-3 vs. F4). In multivariate analysis, fibrosis 1, 2, 3, and 4 stage (compared with F0) (HR: 1.70, 1.81, 1.89, and 3.99, 95% confidence interval: 1.10-1.99, 1.39-2.22, 1.41-2.55, and 2.25-5.01, = 0.022, = 0.008, < 0.001, and < 0.001, respectively) was independent risk factor for RFS. After matched analysis, both RFS and DSS exhibited significantly worse prognoses in the presence of more advanced fibrosis. There was a significantly higher incidence of multiple recurrences in the F4 group than the F1-3 group, and a number of recurrences were observed both in the same hepatic segment as the resected side and in the contralateral lobe in F4 group.
DISCUSSION/CONCLUSION: The hazard and recurrence pattern of HCC signifies that the prognosis could potentially be poor, as the hepatic fibrosis likely owing to a higher hepatocarcinogenic potential, even in the absence of progression to cirrhotic condition. The risk of de novo recurrence may also increase with the progression of this fibrosis.
肝硬化被认为是肝细胞癌（HCC）术后复发的一个促成因素；然而，肝纤维化对两种癌症特异性预后的确切影响仍不清楚。本研究旨在阐明肝纤维化严重程度对癌症特异性预后的影响。
共纳入524例连续患者。根据纤维化分期比较无复发生存期（RFS）和疾病特异性生存期（DSS）。此外，对F0和F1 - 3组以及F1 - 3和F4组患者的术后结果进行分析，这些患者在背景因素方面进行了仔细匹配。
与其他纤维化阶段相比，F4组的5年RFS结果明显更差：5年RFS - F0（46.6%），F1 - 3（33.1%），F4（23.5%），F0与F1 - 3比较P = 0.03，F1 - 3与F4比较P < 0.01。此外，F4组的5年DSS预后也明显更差：5年DSS - F0（82.9%），F1 - 3（73.6%），F4（57.4%），F0与F1 - 3比较P = 0.04，F1 - 3与F4比较P < 0.01。在多因素分析中，纤维化1、2、3和4期（与F0相比）（风险比：1.70、1.81、1.89和3.99，95%置信区间：1.10 - 1.99、1.39 - 2.22、1.41 - 2.55和2.25 - 5.01，P分别为0.022、0.008、< 0.001和< 0.001）是RFS的独立危险因素。匹配分析后，在存在更晚期纤维化的情况下，RFS和DSS的预后均明显更差。F4组的多次复发发生率明显高于F1 - 3组，并且在F4组中观察到在切除侧的同一肝段以及对侧叶均有复发。
讨论/结论：HCC的风险和复发模式表明预后可能较差，因为即使在未进展至肝硬化状态时，肝纤维化可能具有更高的致癌潜力。随着这种纤维化的进展，新发复发的风险也可能增加。
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