Takamoto Takeshi, Nara Satoshi, Ban Daisuke, Mizui Takahiro, Mukai Masami, Esaki Minoru, Shimada Kazuaki
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Eur J Surg Oncol. 2025 Feb;51(2):109461. doi: 10.1016/j.ejso.2024.109461. Epub 2024 Nov 18.
While liver resection remains the best curative option for hepatocellular carcinoma (HCC), it is unclear whether the consistent progress of multidisciplinary approaches in managing HCC over several decades has influenced the outcomes of liver resection.
Patients undergoing liver resection for HCC from 1993 to 2022 in our institution were retrospectively assessed and stratified into three periods according to the year of liver resection, P1 (1993-2000), P2 (2001-2009), and P3 (2010-2022), and tumor status using the Barcelona Clinic Liver Cancer (BCLC) staging system.
A total of 1257 patients were included (P1:P2:P3 = 385:490:382, BCLC stage 0/A:B:C = 908:214:135). In the entire cohort, long-term surgical outcomes significantly improved across the three periods. In BCLC stage 0/A HCC, the 5-year overall survival (OS) rate improved from P1 to P3 (P1: 65.5 %, P2: 71.3 %, P3: 80.4 %), with HRs of 0.655 (95 % CI: 0.536 to 0.800) and 0.595 (95 % CI: 0.455 to 0.778) for P2 vs. P1 and P3 vs. P1, respectively. Conversely, limited advancements were observed in patients with BCLC stage B or C HCC. Multivariate analysis in BCLC stage 0/A patients demonstrated that ICGR15 > 15 %, ALBI grade 2 or 3 (vs. 1), multiple tumors, microvascular invasion, and surgical period (P2 vs.P1) remained independent poor prognostic factors for OS.
Substantial advancements in the long-term outcomes for HCC patients undergoing liver resection, particularly in BCLC stage 0/A, were observed, while minimal improvement was noted for BCLC stage B and C.
虽然肝切除术仍然是肝细胞癌（HCC）的最佳治愈选择，但几十年来多学科方法在HCC管理方面的持续进展是否影响了肝切除的结果尚不清楚。
对1993年至2022年在我院接受HCC肝切除术的患者进行回顾性评估，并根据肝切除年份分为三个时期，P1（1993 - 2000年）、P2（2001 - 2009年）和P3（2010 - 2022年），并使用巴塞罗那临床肝癌（BCLC）分期系统评估肿瘤状态。
共纳入1257例患者（P1:P2:P3 = 385:490:382，BCLC 0/A期:B期:C期 = 908:214:135）。在整个队列中，三个时期的长期手术结果有显著改善。在BCLC 0/A期HCC患者中，5年总生存率（OS）从P1期到P3期有所提高（P1期：65. %，P2期：71.3%，P3期：80.4%），P2期与P1期相比以及P3期与P1期相比的风险比（HR）分别为0.655（95%置信区间：0.536至0.800）和0.595（95%置信区间：0.455至0.778）。相反，BCLC B期或C期HCC患者的进展有限。BCLC 0/A期患者的多因素分析表明，吲哚菁绿15分钟滞留率（ICGR15）> 15%、ALBI 2级或3级（vs. 1级）、多肿瘤、微血管侵犯和手术时期（P2期vs.P1期）仍然是OS的独立不良预后因素。
观察到接受肝切除术的HCC患者的长期结果有显著进展，特别是在BCLC 0/A期，而BCLC B期和C期的改善甚微。
