Surgical Treatment of Hepatocellular Carcinoma in North America: Can Hepatic Resection Still Be Justified?

被引:69
作者
Chapman, William C. [1 ]
Klintmalm, Goran [2 ]
Hemming, Alan [3 ]
Vachharajani, Neeta [1 ]
Doyle, Maria B. Majella [1 ]
DeMatteo, Ron [4 ]
Zaydfudim, Victor [5 ]
Chung, Haniee [1 ]
Cavaness, Keith [2 ]
Goldstein, Robert [2 ]
Zendajas, Ivan [7 ]
Melstrom, Laleh G. [6 ]
Nagorney, David [8 ]
Jarnagin, William [4 ]
机构
[1] Washington Univ, Sch Med, Dept Surg, Sect Abdominal Transplantat, St Louis, MO 63110 USA
[2] Baylor Univ, Dept Surg, Waco, TX 76798 USA
[3] Univ Calif San Diego, Hlth Syst, San Diego, CA 92103 USA
[4] Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA
[5] Univ Virginia, Hlth Syst, Charlottesville, VA USA
[6] Rutgets Robert Wood Johnson Med Sch, Canc Inst New Jersey, New Brunswick, NJ USA
[7] Univ Florida Hlth, Gainesville, FL USA
[8] Mayo Clin, Rochester, MN USA
关键词
LIVER RESECTION; INTRAHEPATIC RECURRENCE; MULTICENTRIC ORIGIN; REASONABLE STRATEGY; CIRRHOTIC-PATIENTS; MILAN CRITERIA; TRANSPLANTATION; SURVEILLANCE; METAANALYSIS; METASTASIS;
D O I
10.1016/j.jamcollsurg.2014.12.030
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: The incidence of hepatocellular cancer (HCC) is increasing dramatically worldwide. Optimal management remains undefined, especially for well-compensated cirrhosis and HCC. STUDY DESIGN: This retrospective analysis included 5 US liver cancer centers. Patients with surgically treated HCC between 1990 and 2011 were analyzed; demographics, tumor characteristics, and survival rates were included. RESULTS: There were 1,765 patients who underwent resection (n = 884, 50.1%) or transplantation (n = 881, 49.9%). Overall, 248 (28.1%) resected patients were transplant eligible (1 tumor <5 cm or 2 to 3 tumors all <3 cm, no major vascular invasion); these were compared with 496 transplant patients, matched based on year of transplantation and tumor status. Overall survivals at 5 and 10 years were significantly improved for transplantation patients (74.3% vs 52.8% and 53.7% vs 21.7% respectively, p < 0.001), with greater differences in disease-free survival (71.8% vs 30.1% at 5 years and 53.4% vs 11.7% at 10 years, p < 0.001). Ninety-seven of the 884 (11%) resected patients were within Milan criteria and had cirrhosis; these were compared with the 496 transplantation patients, with similar results to the overall group. On multivariate analysis, type of surgery was an independent variable affecting all survival outcomes. CONCLUSIONS: The increasing incidence of HCC stresses limited resources. Although transplantation results in better long-term survival, limited donor availability precludes widespread application. Hepatic resection will likely remain a standard therapy in selected patients with HCC. In this large series, only about 10% of patients with cirrhosis were transplant-eligible based on tumor status. Although liver transplantation results are significantly improved compared with resection, transplantation is available only for a minority of patients with HCC. (C) 2015 by the American College of Surgeons
引用
收藏
页码:628 / 637
页数:10
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