肝细胞癌伴微血管侵犯不同切缘方案下根治术的预后分析

肝脏 ›› 2023, Vol. 28 ›› Issue (8): 921-923.

肝细胞癌伴微血管侵犯不同切缘方案下根治术的预后分析

聂彬, 赵铁军, 张胜龙

610219 四川成都京东方医院普外中心(聂彬,赵铁军);重庆医科大学附属成都第二临床教学培训中心,成都市第二人民医院(张胜龙)

收稿日期:2022-10-08 出版日期:2023-08-31 发布日期:2023-09-21
通讯作者: 聂彬,Email: xingqijiu099@163.com

A prognostic analysis on the radical resection of primary hepatocellular carcinoma with microvascular invasion by different resection margin schemes

NIE Bin¹, ZHAO Tie-jun¹, ZHANG Sheng-long²

1. General Surgery Center,Chengdu BOE Hospital, Sichuan 610219,China;
2. Chengdu Second Clinical Teaching and Training Center Affiliated to Chongqing Medical University, Chengdu Second People's Hospital, Sichuan 610021,China

Received:2022-10-08 Online:2023-08-31 Published:2023-09-21
Contact: NIE Bin,Email: xingqijiu099@163.com

摘要/Abstract

摘要： 目的探讨肝细胞癌(HCC)伴微血管侵犯(MVI)不同切缘方案下根治术的预后情况。方法收集成都京东方医院及成都市第二人民医院2016年1月—2022年4月期间接受根治性肝切除术的HCC患者145例,男性88例,女性57例,平均年龄为(52.7±7.8)岁。根据手术切缘宽度分为<1 cm组(99例,A组)和>1 cm组(46例,B组)。对两组患者进行为期1年的随访,比较两组临床资料、手术以及术后随访资料。结果 A组AFP水平为(810.4±80.4)ng/mL,显著高于B组[(790.1±77.3)ng/mL,P<0.05],而两组患者年龄、男性、BMI、病毒感染、Child-Pugh分级、ICG R15、既往史及临床分期比较差异均无统计学意义(P>0.05)。对两组患者手术、预后情况进行随访。A组输血、术后并发症例数及1年总生存率分别为19例(19.2%)、7例(7.1%)及66例(66.7%),均显著低于B组[17例(36.9%)、10例(21.7%)及38例(82.6%),P<0.05];A组MVI及1年肿瘤复发率分别为30例(30.3%)及58例(58.6%),与B组[4例(8.7%)及13例(28.3%)]相比差异具有统计学意义(P<0.05)。结论相较于<1 cm,HCC患者根治性肝切除术切缘宽度>1 cm MVI及肿瘤复发率更低,同时总体生存情况更为理想,但术后并发症、输血例数较高。

关键词: 肝细胞癌, 微血管侵犯, 切缘宽度, 预后

Abstract: Objective To perform the prognostic analyses and comparison of primary hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI) treated by different resection margin schemes.Methods A total of 145 HCC patients who underwent radical hepatectomy from January 2016 to April 2022 in Chengdu BOE Hospital were collected, including 88 males and 57 females, with an average age of (52.7±7.8) years. According to the width of surgical margin, the patients were divided into a <1 cm group (Group A, n=99 cases) and a >1 cm group (Group B, n=46 cases). Both groups of patients were followed up for one year, and the clinical data, operative and postoperative follow-up data of these two groups of patients were compared.Results The AFP level in group A was (810.4±80.4) ng/mL, which was significantly higher than that in group B (790.1±77.3) ng/mL (P<0.05), but there was no statistical difference in age, male, BMI, virus infection, Child-Pugh grade, ICG R15, past history and clinical stage between the two groups (P>0.05). The number of blood transfusion, postoperative complications and one-year overall survival rate in group A were 19 (19.2%), 7 (7.1%) and 66 (66.7%), which were significantly lower than those of 17 (36.9%), 10 (21.7%) and 38 (82.6%) in group B, respectively (P<0.05). In group A, the tumor recurrence rates in patients with MVI and in one-year post operation were 30 (30.3%) and 58 (58.6%) cases, respectively, compared with those of 4 (8.7%) and 13 (28.3%) cases in group B, the difference was statistically significant (P<0.05).Conclusion Compared with <1 cm group, the MVI and tumor recurrence rate after radical hepatectomy in HCC patients with width >1 cm group are lower, and the overall survival situation is better, but the numbers of postoperative complications and cases of blood transfusion are higher.

Key words: Primary hepatocellular carcinoma, Microvascular invasion, Margin width, Prognosis

聂彬, 赵铁军, 张胜龙. 肝细胞癌伴微血管侵犯不同切缘方案下根治术的预后分析[J]. 肝脏, 2023, 28(8): 921-923.

NIE Bin, ZHAO Tie-jun, ZHANG Sheng-long. A prognostic analysis on the radical resection of primary hepatocellular carcinoma with microvascular invasion by different resection margin schemes[J]. Chinese Hepatolgy, 2023, 28(8): 921-923.

参考文献

[1] Torre LA, Bray F , Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin,2015,65(2):87-108.
[2] Si MB, Yan PJ, Hao XY, et al. Efficacy and safety of radiofrequency ablation versus minimally invasive liver surgery for small hepatocellular carcinoma: a systematic review and meta-analysis. Surg Endosc,2019,33(8):2419-2429.
[3] Zhong FP, Zhang YJ, Liu Y. Prognostic impact of surgical margin in patients with hepatocellular carcinoma: A meta-analysis. Medicine (Baltimore),2017,96(37):8043.
[4] Chakraborty J, Simpson A L. Preoperative assessment of microvascular invasion in hepatocellular carcinoma. BMC Cancer,2017,7(2):101-109.
[5] 原发性肝癌诊疗规范(2017年版). 中华肝脏病杂志,2017,25(12):886-895.
[6] Costentin CE, Decaens T, Laurent A, et al. Sorafenib vs surgical resection for hepatocellular carcinoma with macrovascular invasion: A propensity score analysis. Liver Int,2017,37(12):1869-1876.
[7] El-Domiaty N, Saliba F, Vibert E, et al. Early versus late hepatocellular carcinoma recurrence after transplantation: predictive factors, patterns, and long-term outcome. Transplantation,2021,105(8):1778-1790.
[8] Nitta H, Allard MA, Sebagh M, et al. Ideal surgical margin to prevent early recurrence after hepatic resection for hepatocellular carcinoma.World J Surg,2021,45(4):1159-1167.
[9] Tsilimigras DI, Sahara K, Moris D, et al. Effect of surgical margin width on patterns of recurrence among patients undergoing R0 hepatectomy for T1 hepatocellular carcinoma: An international multi-institutional analysis. J Gastrointest Surg,2020,24(7):1552-1560.
[10] Reginelli A, Vanzulli A, Sgrazzutti C, et al. Vascular microinvasion from hepatocellular carcinoma: CT findings and pathologic correlation for the best therapeutic strategies. Med Oncol,2017,34(5):93.
[11] Kawaoka T,Aikata H,Inagaki Y,et al. Enhanced ultrasonography detection of mucosa-associated lymphoid tissue of the liver with penetrating vessels in a tumor-case report. Kanzo,2017,58(5):280-288.
[12] Isik B, Gonultas F, Sahin T, et al. Microvascular venous invasion in hepatocellular carcinoma: why do recurrences occur? J Gastrointest Cancer,2020,51(4):1133-1136.
[13] Shi M, Guo RP, Lin XJ, et al. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial. Ann Surg.2007,245(1):36-43.
[14] Erstad DJ, Tanabe KK. Prognostic and therapeutic implications of microvascular invasion in hepatocellular carcinoma. Ann Surg Oncol,2019,26(5):1474-1493.
[15] Poon RT, Fan ST, Ng IO, et al. Significance of resection margin in hepatectomy for hepatocellular carcinoma: A critical reappraisal. Ann Surg,2000,231(4):544-51.