Background: The long-term prognosis after liver resection for multinodular (≥3 nodules) hepatocellular carcinoma (HCC) is generally considered to be unfavorable. However, the role of liver resection for binodular HCC is less investigated.
Subjects, materials, and methods: From a multicenter database, consecutive patients who underwent curative-intent liver resection for binodular HCC and without macrovascular invasion between 2003 and 2015 were retrospectively reviewed. Patients' clinical variables as well as perioperative and long-term survival outcomes were analyzed. Univariable and multivariable analyses were performed to identify the risk factors associated with overall survival (OS) and recurrence-free survival (RFS) after curative resection.
Results: Of 263 enrolled patients, the perioperative 30-day mortality and morbidity rates were 1.5% and 28.5%. The 1-, 3-, and 5-year OS and RFS rates were 81.5%, 52.4%, and 39.1% and 57.1%, 35.8%, and 26.6%, respectively. Multivariable Cox-regression analyses identified preoperative alpha-fetoprotein level >400 μg/L, tumor size with a sum of two nodules >8 cm, tumor size ratio of large/small nodule >1.5 (asymmetrical proportion), unilateral hemiliver distribution of two nodules, distance of ≤3 cm between two nodules, and microvascular invasion in any nodule as independent risk factors associated with decreased OS and RFS.
Conclusion: Liver resection was safe and feasible in patients with binodular HCC, with acceptable perioperative and long-term outcomes. Sum of two tumor sizes, size ratio and distribution, and distance between two nodules were independent risk factors associated with long-term survival outcomes after surgery. These results may guide clinicians to make individualized surgical decisions and estimate long-term prognosis for these patients.
Implications for practice: Liver resection was safe and feasible in patients with binodular hepatocellular carcinoma, with acceptable perioperative and long-term outcomes. The sum of two tumor sizes, the size ratio and distribution of the two nodules, and the distance between two nodules were independent risk factors associated with long-term overall survival and recurrence-free survival after liver resection. The results of this study may guide clinicians to make individualized surgical decisions, estimate long-term prognosis, and plan recurrence surveillance and adjuvant therapy for these patients.
摘要
背景。一般认为，多结节(≥3 个结节)型肝细胞癌 (HCC) 肝切除术后的长期预后不佳。然而，对于肝切除术在双结节型HCC中发挥的作用研究较少。
受试者、材料和方法。我们从一个多中心数据库中查找 2003 年至 2015 年间连续接受根治性肝切除术以治疗双结节型HCC且无大血管侵犯的患者，并进行了回顾性分析。我们对患者的临床变量及围手术期和长期生存预后进行了分析。同时，进行了单变量和多变量分析，以确定与根治性切除术后总生存期 (OS) 和无复发生存期 (RFS) 相关的风险因素。
结果。在纳入的 263 例患者中，围手术期 30 天死亡率和病损率分别为 1.5% 和 28.5%。1 年、3 年和 5 年的OS率分别为 81.5%、52.4% 和 39.1%，RFS率分别为 57.1%、35.8% 和
26.6%。在多变量 Cox 回归分析中，将术前 α‐胎蛋白水平大于 400 μg/L、两个结节肿瘤大小之和大于 8 cm、大/小结节肿瘤的大小比大于 1.5(不对称比例)、两个结节单侧半肝分布、两个结节的间距小于(含)3 cm，以及任意结节中存在微血管侵犯作为导致OS和RFS缩短的独立风险因素。
结论。肝切除术在双结节型HCC患者中安全可行，其围手术期和长期预后均可接受。两个肿瘤大小之和、大小比及分布以及两个结节之间的距离是与术后长期生存预后相关的独立风险因素。这些结果可指导临床医师针对每个患者的具体情况做出手术决策，并对这些患者的长期预后进行评估。
实践意义:肝切除术在双结节型肝细胞癌患者中安全可行，其围手术期和长期预后均可接受。两个肿瘤大小之和、大小比及分布以及两个结节之间的距离是与术后长期总生存期和无复发生存期相关的独立风险因素。本研究的结果可指导临床医师针对每个患者的具体情况做出手术决策，并对这些患者的长期预后进行评估，以及为这些患者制定复发监测和辅助治疗方案。
Keywords: Hepatectomy; Hepatocellular carcinoma; Intrahepatic metastasis; Multicentric origin; Overall survival; Recurrence‐free survival.
© AlphaMed Press 2019.