Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan.
Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan.
Dig Dis Sci. 2024 Aug;69(8):3069-3078. doi: 10.1007/s10620-024-08500-y. Epub 2024 Jun 1.
In many Asian hepatocellular carcinoma (HCC) guidelines, resection is an option for multiple HCCs. It is difficult to compare small but multiple tumors vs. fewer large tumors in terms of the traditional tumor burden definition. We aimed to evaluate the role of liver resection for multiple HCCs and determine factors associated with survival benefits.
We reviewed 160 patients with multiple HCCs who underwent liver resection between July 2003 and December 2018. The risk factors for tumor recurrence were assessed using Cox proportional hazards modeling, and survival was analyzed using the Kaplan-Meier method.
In all 160 patients, 133 (83.1%) exceeded the Milan criteria. Total tumor volume (TTV) > 275 cm and serum alpha-fetoprotein (AFP) level > 20 ng/mL were associated with disease-free survival. Patients beyond the Milan criteria were grouped into three risk categories: no risk (TTV ≤ 275 cm and AFP ≤ 20 ng/mL, n = 39), one risk (either TTV > 275 cm or AFP > 20 ng/mL, n = 76), and two risks (TTV > 275 cm and AFP > 20 ng/mL, n = 18). No-risk group had comparable disease-free survival (p = 0.269) and overall survival (p = 0.215) to patients who met the Milan criteria.
Patients with TTV ≤ 275 cm and AFP ≤ 20 ng/mL can have good outcomes even exceed the Milan criteria.
在许多亚洲肝细胞癌（HCC）指南中，切除术是多个 HCC 的选择。根据传统的肿瘤负担定义，比较多个小肿瘤与较少的大肿瘤是困难的。我们旨在评估肝切除术治疗多个 HCC 的作用，并确定与生存获益相关的因素。
我们回顾了 2003 年 7 月至 2018 年 12 月期间接受肝切除术治疗的 160 例多个 HCC 患者。使用 Cox 比例风险模型评估肿瘤复发的危险因素，并使用 Kaplan-Meier 方法分析生存情况。
在所有 160 例患者中，133 例（83.1%）超过了米兰标准。总肿瘤体积（TTV）>275cm 和血清甲胎蛋白（AFP）水平>20ng/mL 与无病生存相关。超出米兰标准的患者被分为三个风险类别：无风险（TTV≤275cm 和 AFP≤20ng/mL，n=39）、一个风险（TTV>275cm 或 AFP>20ng/mL，n=76）和两个风险（TTV>275cm 和 AFP>20ng/mL，n=18）。无风险组与符合米兰标准的患者的无病生存率（p=0.269）和总生存率（p=0.215）相当。
即使超出米兰标准，TTV≤275cm 和 AFP≤20ng/mL 的患者也可以获得良好的结果。
