Chen Jiafeng, Fang Yuan, Tang Zheng, Dong Enfu, Gao Jun, Zhu Guiqi, Kwangwari Pascal, Feng Shanru, Qu Weifeng, Wu Xiaoling, Mao Shengwei, Zhao Qianfu, Wang Yi, Yang Rui, Guan Zhiqi, Chu Tianhao, Bu Yichao, Zhou Jian, Fan Jia, Fu Xiutao, Liu Weiren, Ding Zhenbin, Shi Yinghong
Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
Research Unit of Liver Cancer Recurrence and Metastasis, Chinese Academy of Medical Sciences, Beijing, China.
Hepatol Int. 2025 Feb 22. doi: 10.1007/s12072-025-10786-7.
Hepatocellular carcinoma (HCC) is the most prevalent type of primary liver cancer, characterized by a high rate of recurrence. This study aims to compare the efficacy and safety of repeat hepatectomy (RH) and salvage liver transplantation (sLT) for recurrent hepatocellular carcinoma (rHCC) and explores the predictive value of neutrophil-to-lymphocyte ratio (NLR) and neutrophil extracellular traps (NETs).
In this study, consecutive patients receiving RH (n = 637) or sLT (n = 53) for rHCC within the University of California San Francisco (UCSF) Criteria were recruited. After propensity score matching (PSM), disease-free survival (DFS) and overall survival (OS) were compared utilizing the Kaplan-Meier method. Additionally, the level of neutrophil infiltration and NETs were analyzed by multiplex immunofluorescence.
After PSM, the sLT group demonstrated superior 5-year DFS and OS compared to the RH group (p < 0.001 and p = 0.014). Subgroup analysis demonstrated that NLR > 2.3 was associated with poorer OS (p < 0.001 in the RH group and p = 0.024 in the sLT group) and DFS (p = 0.002 in both groups). Furthermore, we identified that patients in the sLT group are more susceptible to extrahepatic metastasis. In addition, our results revealed that higher infiltration of intratumoral neutrophils was negatively correlated with OS and DFS (p = 0.002 and p = 0.001, respectively), especially in cases with higher NETs level.
This study indicates that sLT achieves better long-term outcomes than RH for rHCC. NLR and NETs formation are promising prognostic factors for HCC.
肝细胞癌（HCC）是原发性肝癌最常见的类型，其特点是复发率高。本研究旨在比较复发性肝细胞癌（rHCC）再次肝切除术（RH）和挽救性肝移植（sLT）的疗效和安全性，并探讨中性粒细胞与淋巴细胞比值（NLR）和中性粒细胞胞外诱捕网（NETs）的预测价值。
本研究纳入了在加利福尼亚大学旧金山分校（UCSF）标准范围内接受RH（n = 637）或sLT（n = 53）治疗rHCC的连续患者。经过倾向评分匹配（PSM）后，采用Kaplan-Meier方法比较无病生存期（DFS）和总生存期（OS）。此外，通过多重免疫荧光分析中性粒细胞浸润水平和NETs。
PSM后，sLT组的5年DFS和OS均优于RH组（p < 0.001和p = 0.014）。亚组分析表明，NLR > 2.3与较差的OS（RH组p < 0.001，sLT组p = 0.024）和DFS（两组均为p = 0.002）相关。此外，我们发现sLT组患者更容易发生肝外转移。另外，我们的结果显示，肿瘤内中性粒细胞浸润增加与OS和DFS呈负相关（分别为p = 0.002和p = 0.001），尤其是在NETs水平较高的情况下。
本研究表明，对于rHCC，sLT比RH能取得更好的长期疗效。NLR和NETs形成是HCC有前景的预后因素。
