门静脉侵犯的肝细胞癌手术切除的临床意义：一项全国性队列研究
Clinical significance of surgical resection for hepatocellular carcinoma with portal vein invasion: a nationwide cohort study.
作者信息
Jo Hye-Sung, Park Pyoung-Jae, Yu Young-Dong, Choi Yoo Jin, Yu Se Hyeon, Kim Dong-Sik
机构信息
Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
Division of Transplantation and Vascular Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
出版信息
Hepatobiliary Surg Nutr. 2024 Oct 1;13(5):814-823. doi: 10.21037/hbsn-23-578. Epub 2024 Jun 25.
BACKGROUND
Hepatocellular carcinoma (HCC) with portal vein invasion (PVI) is considered an advanced stage with a poor prognosis. Although current guidelines recommend systemic treatment for HCC with PVI, surgical resection could produce acceptable outcomes in selected patients. This study aimed to identify the clinical significance of surgical resection for HCC with PVI patients using a large-scale nationwide registry.
METHODS
This retrospective, multicenter, observational cohort analyzed data from the Korean Primary Liver Cancer Registry. A total of 16,781 patients who were newly diagnosed with HCC between 2008 and 2018 were enrolled in this study. Patients with worse Child-Turcotte-Pugh scores (≥7) or performance status (≥2) were excluded. Among them, 998 patients who received treatment for HCC with PVI were included in the analysis and were divided into two groups: resection group of 151 (15.1%) and palliative group of 847 (84.9%) who received transarterial and systemic therapy according to the treatment intent. After matching the number and size of the tumors and model for end-stage liver disease (MELD) score between the groups, the final study cohort for analysis comprised 151 (26.6%) patients in the resection group and 417 (73.4%) in the palliative group. The primary endpoints were overall survival (OS) and cancer-specific survival (CSS).
RESULTS
The number and maximum size of HCC did not differ between the resection and palliative groups after matching [1 (range, 1-5) 1 (range, 1-6), P=0.11 and 5.5 (range, 1.2-20.6) 6.0 (range, 1.0-20.5) cm, P=0.24, respectively]. Tumor markers, including alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II), also did not differ between the groups (P=0.29 and P=0.36, respectively). The 5-year OS and CSS rates of the resection and palliative groups were 44.8% and 17.4% (P<0.001) and 47.7% and 18.6% (P<0.001), respectively. Multivariate analysis showed that palliative treatment intent was the most significant risk factor for OS and CSS [odds ratio (OR) =2.24; 95% confidence interval (CI): 1.66-3.02; P<0.001 and OR =2.29; 95% CI: 1.68-3.12; P<0.001, respectively].
CONCLUSIONS
Surgical resection could significantly improve OS and CSS in selected HCC with PVI patients who have preserved liver function and performance status.
背景
伴有门静脉侵犯（PVI）的肝细胞癌（HCC）被认为是晚期，预后较差。尽管当前指南推荐对伴有PVI的HCC进行全身治疗，但手术切除在部分患者中可产生可接受的结果。本研究旨在利用全国范围的大型登记数据库确定手术切除对伴有PVI的HCC患者的临床意义。
方法
这项回顾性、多中心、观察性队列研究分析了韩国原发性肝癌登记数据库中的数据。共有16781例在2008年至2018年间新诊断为HCC的患者纳入本研究。排除Child-Turcotte-Pugh评分较差（≥7分）或体能状态（≥2分）的患者。其中，998例接受伴有PVI的HCC治疗的患者纳入分析，并分为两组：151例（15.1%）的切除组和847例（84.9%）的姑息治疗组，后者根据治疗意向接受经动脉和全身治疗。在匹配两组间肿瘤数量、大小及终末期肝病模型（MELD）评分后，最终用于分析的研究队列包括切除组中的151例（26.6%）患者和姑息治疗组中的417例（73.4%）患者。主要终点为总生存期（OS）和癌症特异性生存期（CSS）。
结果
匹配后，切除组和姑息治疗组的HCC数量及最大直径无差异[分别为1（范围1 - 5）对1（范围1 - 6），P = 0.11；5.5（范围1.2 - 20.6）对6.0（范围1.0 - 20.5）cm，P = 0.24]。包括甲胎蛋白（AFP）和维生素K缺乏或拮抗剂-II诱导蛋白（PIVKA-II）在内的肿瘤标志物在两组间也无差异（分别为P = 0.29和P = 0.36）。切除组和姑息治疗组的5年OS率和CSS率分别为44.8%和17.4%（P < 0.001）以及47.7%和18.6%（P < 0.001）。多因素分析显示，姑息治疗意向是OS和CSS的最显著危险因素[比值比（OR）= 2.24；95%置信区间（CI）：1.66 - 3.02；P < 0.001和OR = 2.29；95% CI：1.68 - 3.12；P < 0.001]。
结论
手术切除可显著改善肝功能和体能状态良好的部分伴有PVI的HCC患者的OS和CSS。
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