Liver Resection Improves the Survival of Patients with Multiple Hepatocellular Carcinomas

详细信息    查看全文

• 作者：Ming-Chih Ho MD ; PhD (1)
  Guan-Tarn Huang MD ; PhD (2)
  Yuk-Ming Tsang MD (3)
  Po-Huang Lee MD ; PhD (1)
  Ding-Shinn Chen MD (2) (4) (5)
  Jin-Chuan Sheu MD ; PhD (2)
  Chien-Hung Chen MD ; PhD (2)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2009
• 出版时间：April 2009
• 年：2009
• 卷：16
• 期：4
• 页码：848-855
• 全文大小：283KB
• 参考文献：1. Befeler AS, Di Bisceglie AM. Hepatocellular carcinoma: diagnosis and treatment. / Gastroenterology. 2002;122:1609-9. CrossRef
  2. Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. / Int J Cancer. 2001;94:153-. CrossRef
  3. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. / N Engl J Med. 1996;334:693-. CrossRef
  4. Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. / Hepatology. 2001;33:1394-03. CrossRef
  5. Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C, et al. Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. / Ann Surg. 1999;229:322-0. CrossRef
  6. Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, et al. One thousand fifty-six hepatectomies without mortality in 8?years. / Arch Surg. 2003;138:1198-06; discussion 206. CrossRef
  7. Bruix J, Sherman M. Management of hepatocellular carcinoma. / Hepatology. 2005;42:1208-6. CrossRef
  8. Makuuchi M, Kokudo N, Arii S, Futagawa S, Kaneko S, Kawasaki S, et al. Development of evidence-based clinical guidelines for the diagnosis and treatment of hepatocellular carcinoma in Japan. / Hepatol Res. 2008;38:37-1. CrossRef
  9. Lee SG, Hwang S. How I do it: assessment of hepatic functional reserve for indication of hepatic resection. / J Hepatobiliary Pancreat Surg. 2005;12:38-3. CrossRef
  10. Wu CC, Cheng SB, Ho WM, Chen JT, Liu TJ, P’Eng FK. Liver resection for hepatocellular carcinoma in patients with cirrhosis. / Br J Surg. 2005;92:348-5. CrossRef
  11. Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, et al. AJCC cancer staging manual. 6th ed. Chicago: Springer; 2002.
  12. The Z. The Cancer of the Liver Italian Program (CLIP) investigators A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients. / Hepatology. 1998;28:751-. CrossRef
  13. Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. / Semin Liver Dis. 1999;19:329-8. CrossRef
  14. Makuuchi M, Sano K. The surgical approach to HCC: our progress and results in Japan. / Liver Transpl. 2004;10:S46-2. CrossRef
  15. Ishizawa T, Hasegawa K, Aoki T, Takahashi M, Inoue Y, Sano K, et al. Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. / Gastroenterology. 2008;134:1908-6. CrossRef
  16. Torzilli G, Donadon M, Marconi M, Palmisano A, Del Fabbro D, Spinelli A, et al. Hepatectomy for stage B and stage C hepatocellular carcinoma in the Barcelona clinic liver cancer classification: results of a prospective analysis. / Arch Surg. 2008;143:1082-0. CrossRef
  17. Wang JH, Changchien CS, Hu TH, Lee CM, Kee KM, Lin CY, et al. The efficacy of treatment schedules according to Barcelona Clinic Liver Cancer staging for hepatocellular carcinoma—Survival analysis of 3892 patients. / Eur J Cancer. 2008;44:1000-. CrossRef
  18. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. / Hepatology. 2003;37:429-2. CrossRef
  19. Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon, RT, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. / Hepatology. 2002;35:1164-1.
  20. Llovet JM, Real MI, Monta?a X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. / Lancet. 2002;359:1734-. CrossRef
  21. Huang YH, Chen CH, Chang TT, Chen SC, Chiang JH, Lee HS, et al. The role of transcatheter arterial embolization for patients with unresectable hepatocellular carcinoma: a nationwide, multicentre study evaluated by cancer stage. / Aliment Pharmacol Ther. 2005;21:687-4. CrossRef
  22. Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in advanced hepatocellular carcinoma. / N Engl J Med. 2008;359:378-0. CrossRef
  23. Llovet JM, Bruix J. Molecular targeted therapies in hepatocellular carcinoma. / Hepatology. 2008;48:1312-7. CrossRef
  24. Lin CY, Kee KM, Wang JH, Lee CM, Chen CL, Changchien CS, et al. Is the Cancer of the Liver Italian Program system an adequate weighting for survival of hepatocellular carcinoma? Evaluation of intrascore prognostic value among 36 subgroups. / Liver Int. 2009;29:74-1. CrossRef
  
• 作者单位：Ming-Chih Ho MD, PhD (1)
  Guan-Tarn Huang MD, PhD (2)
  Yuk-Ming Tsang MD (3)
  Po-Huang Lee MD, PhD (1)
  Ding-Shinn Chen MD (2) (4) (5)
  Jin-Chuan Sheu MD, PhD (2)
  Chien-Hung Chen MD, PhD (2)
  
  1. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
  2. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
  3. Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
  4. Graduate Institute of Clinical Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
  5. Hepatitis Research Center, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
  

文摘

Background According to current guidelines of hepatocellular carcinoma (HCC) treatment, multiple HCCs are usually not suitable for surgical resection. However, surgical resection is still possible for patients with multiple HCCs. The role of hepatic resection vs transarterial chemoembolization (TACE) for multiple HCCs should be further clarified. Methods We retrospectively enrolled 1065 patients with multiple HCCs. Among them, 294 received surgical resection, 367 received transarterial chemoembolization (TACE), and 404 received chemotherapy or supportive care. Three staging systems (TNM, CLIP, and BCLC) were used for comparison of stage-specific survival between different treatment modalities. Results The median survival of multiple HCC patients who received surgical resection was 37.9?months, while it was 17.3?months in TACE group, and 2.8?months in supportive group (P < .001). The 1-year, 3-year, 5-year survival rates for surgical group were 77.4%, 51.9%, and 36.6%, respectively. Kaplan-Meier survival analysis demonstrated that patients who received surgical resections had the best survival, followed by TACE and supportive care. For patients of the same stage, surgical resection yields better results than TACE. Surgery could offer better survival than TACE for patients either within or beyond Milan’s criteria. Conclusions Our results indicate that if patients have preserved liver functions, hepatic resection is helpful, even for patients with multiple HCCs.