Kim Aryoung, Song Byeong Geun, Kang Wonseok, Gwak Geum-Youn, Paik Yong-Han, Choi Moon Seok, Lee Joon Hyeok, Goh Myung Ji, Sinn Dong Hyun
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
Gut Liver. 2025 Mar 15;19(2):265-274. doi: 10.5009/gnl240214. Epub 2025 Feb 11.
BACKGROUND/AIMS: The aim of this study was to investigate the effect of a surgical treatment algorithm recently proposed by the American Association for the Study of Liver Diseases (AASLD) on survival outcomes in patients with early-stage hepatocellular carcinoma (HCC) and identify effective alternative treatment modalities when liver transplantation (LT) is not available.
We studied the clinical data of 1,442 patients who were diagnosed with early-stage HCC (a single lesion measuring 2-5 cm in size or 2 to 3 lesions measuring ≤3 cm in size) between 2013 and 2018 and classified as Child-Turcotte-Pugh (CTP) A or B. Analyses were separately performed for individuals recommended for resection (single lesion, CTP A and no clinically significant portal hypertension) and those recommended for LT (single lesion with impaired liver function such as CTP B or clinically significant portal hypertension or multiple lesions).
Of 791 patients recommended for surgical resection, 85.8% underwent resection. The 5-year survival rate was higher for patients who underwent surgical resection than for those who received other treatments (89.4% vs 72.3%). Among 651 patients recommended for LT, only 3.4% underwent the procedure. The most common alternative treatment modalities were transarterial therapy (39.3%) followed by resection (28.9%) and ablation (27.8%). The overall survival rate associated with transarterial therapy was lower than that for resection and ablation, whereas that of the latter two treatments were comparable.
The survival outcomes of treatment strategies that most closely aligned with the algorithm proposed by the AASLD were superior to those of alternative treatment approaches. However, LT in patients with early-stage HCC can be challenging. When LT is not feasible, resection and ablation can be considered first-line alternative options.
背景/目的：本研究旨在探讨美国肝病研究协会（AASLD）最近提出的手术治疗方案对早期肝细胞癌（HCC）患者生存结局的影响，并确定在无法进行肝移植（LT）时有效的替代治疗方式。
我们研究了2013年至2018年间被诊断为早期HCC（单个病灶大小为2 - 5厘米或2至3个病灶大小≤3厘米）且分类为Child-Turcotte-Pugh（CTP）A或B级的1442例患者的临床数据。对推荐进行切除术的个体（单个病灶、CTP A级且无临床显著门静脉高压）和推荐进行LT的个体（如CTP B级或临床显著门静脉高压的单个病灶或多个病灶伴肝功能受损）分别进行分析。
在791例推荐进行手术切除的患者中，85.8%接受了切除术。接受手术切除的患者5年生存率高于接受其他治疗的患者（89.4%对72.3%）。在651例推荐进行LT的患者中，仅3.4%接受了该手术。最常见的替代治疗方式是经动脉治疗（39.3%），其次是切除术（28.9%）和消融术（27.8%）。与经动脉治疗相关的总生存率低于切除术和消融术，而后两种治疗的总生存率相当。
与AASLD提出的方案最密切相关的治疗策略的生存结局优于替代治疗方法。然而，早期HCC患者的LT可能具有挑战性。当LT不可行时，切除术和消融术可被视为一线替代选择。
