Impact of tumor size on the prognosis of hepatocellular carcinoma in patients who underwent liver resection

被引:39
作者
Dai, Chia-Yen [1 ,2 ,3 ,4 ]
Lin, Ching-Yeh [5 ]
Tsai, Pei-Chien [1 ]
Lin, Ping-Yi [6 ]
Yeh, Ming-Lun [1 ,4 ]
Huang, Chung-Feng [1 ,2 ,4 ]
Chang, Wen-Tsan [7 ]
Huang, Jee-Fu [1 ,4 ]
Yu, Ming-Lung [1 ,2 ,4 ]
Chen, Yao-Li [4 ,6 ]
机构
[1] Kaohsiung Med Univ, Kaohsiung Med Univ Hosp, Dept Internal Med, Hepatobiliary Div, Kaohsiung, Taiwan
[2] Kaohsiung Med Univ, Kaohsiung Med Univ Hosp, Dept Occupat & Environm Med, Kaohsiung, Taiwan
[3] Kaohsiung Med Univ, Kaohsiung Med Univ Hosp, Hlth Management Ctr, Kaohsiung, Taiwan
[4] Kaohsiung Med Univ, Coll Med, Fac Internal Med, Kaohsiung, Taiwan
[5] Changhua Christian Hosp, Dept Med, Div Hematol Oncol, Changhua, Taiwan
[6] Changhua Christian Hosp, Dept Gen Surg, 135 NanHsiao St, Changhua 500, Taiwan
[7] Kaohsiung Med Univ Hosp, Dept Surg, Div HBP Surg, Kaohsiung, Taiwan
关键词
Alpha-fetoprotein; Hepatitis B virus; Hepatitis C virus; Hepatocellular carcinoma; Tumor size; HEPATITIS-C VIRUS; SURVIVAL; RISK; HEPATECTOMY; TRENDS; RECURRENCE; MANAGEMENT; CIRRHOSIS; FIBROSIS; INVASION;
D O I
10.1016/j.jcma.2017.06.018
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Health burdens of hepatocellular carcinoma (HCC) are emerging quickly in the world, including in Taiwan. Surgical resection has been recognized as the first-line treatment for early tumors. This study aimed to investigate the prognostic risk factors for mortality and recurrence rate in Taiwan, which has a high prevalence of chronic viral hepatitis. Methods: A total of 397 HCC patients receiving tumor resection were consecutively examined in central Taiwan from 2008 to 2014. A hospital based patient cohort was designed to collect serological markers to further assess liver function. We modified the Kaplan-Meier method according to the competing death risks for comparing recurrence and used multivariate Cox proportional hazard regression to adjust for significant risk factors. Results: In addition to advanced fibrosis, tumor size >= 5 cm was significantly associated with higher mortality within the 5-year period when compared with <5 cm (43.3% vs. 13.2%, p < 0.0001). Patients with tumor size >= 5 cm also easily progressed to early recurrence within two years when accounting for death as a competing risk (20.1% vs. 10.1%, p = 0.01). Higher AFP levels played a major role in further predicting higher mortality in those patients. We determined that there were a 4.5-fold and 2.2-fold higher mortalities in patients with size >= 5 cm/AFP >= 20 ng/mL and with size >= 5 cm/AFP< 20 ng/mL, respectively, when compared to patients with small tumors. Conclusion: Tumor size >= 5 cm might be a good predicting factor for death and early recurrence when considering death as a competing risk. Copyright (C) 2017, the Chinese Medical Association. Published by Elsevier Taiwan LLC.
引用
收藏
页码:155 / 163
页数:9
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