Liver Resection for Multiple Hepatocellular Carcinomas A Japanese Nationwide Survey

被引：64

作者：

Fukami, Yasuyuki ^{[1
]}

Kaneoka, Yuji ^{[1
]}

Maeda, Atsuyuki ^{[1
]}

Kumada, Takashi ^{[2
]}

Tanaka, Junko ^{[3
]}

Akita, Tomoyuki ^{[3
]}

Kubo, Shoji ^{[4
]}

Izumi, Namiki ^{[5
]}

Kadoya, Masumi ^{[6
]}

Sakamoto, Michiie ^{[7
]}

Nakashima, Osamu ^{[8
]}

Matsuyama, Yutaka ^{[9
]}

Kokudo, Takashi ^{[10
]}

Hasegawa, Kiyoshi ^{[10
]}

Yamashita, Tatsuya ^{[11
]}

Kashiwabara, Kosuke ^{[12
]}

Takayama, Tadatoshi ^{[13
]}

Kokudo, Norihiro ^{[14
]}

Kudo, Masatoshi ^{[15
]}

机构：

[1] Ogaki Municipal Hosp, Dept Surg, Gifu, Japan

[2] Ogaki Municipal Hosp, Dept Gastroenterol, Gifu, Japan

[3] Hiroshima Univ, Inst Biomed & Hlth Sci, Dept Epidemiol Infect Dis Control & Prevent, Hiroshima, Japan

[4] Osaka City Univ, Grad Sch Med, Dept Hepatobiliary Pancreat Surg, Osaka, Japan

[5] Musashino Red Cross Hosp, Dept Gastroenterol, Tokyo, Japan

[6] Shinshu Univ, Sch Med, Dept Radiol, Matsumoto, Nagano, Japan

[7] Keio Univ, Dept Pathol, Sch Med, Tokyo, Japan

[8] Kurume Univ Hosp, Dept Clin Lab Med, Kurume, Fukuoka, Japan

[9] Univ Tokyo, Sch Publ Hlth, Dept Biostat, Tokyo, Japan

[10] Univ Tokyo, Grad Sch Med, Hepatobiliary Pancreat Surg Div, Dept Surg, Tokyo, Japan

[11] Kanazawa Univ, Adv Prevent Med Res Ctr, Kanazawa, Ishikawa, Japan

[12] Univ Tokyo, Sch Publ Hlth, Grad Sch Med, Dept Biostat, Tokyo, Japan

[13] Nihon Univ, Dept Digest Surg, Sch Med, Tokyo, Japan

[14] Natl Ctr Global Hlth & Med, Tokyo, Japan

[15] Kinki Univ, Dept Gastroenterol & Hepatol, Sch Med, Osaka, Japan

来源：

ANNALS OF SURGERY | 2020年 / 272卷 / 01期

基金：

日本学术振兴会;

关键词：

hepatectomy; hepatocellular carcinoma; liver resection; multiple; transarterial chemoembolization; TRANSARTERIAL CHEMOEMBOLIZATION; RADIOFREQUENCY ABLATION; HEPATIC RESECTION; ALPHA-FETOPROTEIN; STAGE B; DIAGNOSIS; SURVIVAL; TRANSPLANTATION; METAANALYSIS; HEPATECTOMY;

D O I：

10.1097/SLA.0000000000003192

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Objective: The aim of the study was to evaluate the survival benefits of liver resection (LR) compared with transarterial chemoembolization (TACE) for patients with multiple hepatocellular carcinomas (HCCs). Background: Despite significant improvements in diagnostic imaging and the widespread application of screening programs, some patients with HCC continue to present with multiple tumors. The surgical indications for multiple HCCs remain controversial. Methods: Among 77,268 patients with HCC reported in a Japanese nationwide survey, 27,164 patients had multiple HCCs. The exclusion criteria were Child-Pugh B/C, treatment other than LR and TACE, >3 tumors, and insufficient available data. Ultimately, 3246 patients (LR:n= 1944, TACE:n= 1302) were included. The survival benefit of LR for patients multiple HCCs was evaluated by using propensity score matching analysis. Results: The study group of 2178 patients (LR:n= 1089, TACE:n= 1089) seemed to be well matched. The overall survival rate in the LR group was 60.0% at 5 years, which was higher than that in the TACE group (41.6%,P< 0.001). Among patients with a tumor size of 30 mm or more, LR showed a survival benefit over TACE at 5 years (53.0% vs 32.7%,P< 0.001). The multivariate analysis indicated that age, serum albumin level, serum alpha-fetoprotein (AFP) level, macrovascular invasion, tumor size, and TACE were independent predictors of poor prognosis in multiple HCCs. Conclusions: LR could offer better long-term survival than TACE for patients with multiple HCCs (up to 3 tumors). If patients have good liver function (Child-Pugh A), LR is recommended, even for those with multiple HCCs with tumor sizes of 30 mm or more.

引用

页码：145 / 154

页数：10

共 38 条

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