Liver Resection Criteria for Patients with Hepatocellular Carcinoma and Multiple Tumors Based on Total Tumor Volume.

IF 2.5 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Digestive Diseases and Sciences Pub Date : 2024-08-01 Epub Date: 2024-06-01 DOI:10.1007/s10620-024-08500-y

Hao-Wen Shih, Yin Lai, Hao-Chien Hung, Jin-Chiao Lee, Yu-Chao Wang, Tsung-Han Wu, Chen-Fang Lee, Ting-Jung Wu, Hong-Shiue Chou, Kun-Ming Chan, Wei-Chen Lee, Chih-Hsien Cheng

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引用次数: 0

Abstract

Background: In many Asian hepatocellular carcinoma (HCC) guidelines, resection is an option for multiple HCCs. It is difficult to compare small but multiple tumors vs. fewer large tumors in terms of the traditional tumor burden definition. We aimed to evaluate the role of liver resection for multiple HCCs and determine factors associated with survival benefits.

Methods: We reviewed 160 patients with multiple HCCs who underwent liver resection between July 2003 and December 2018. The risk factors for tumor recurrence were assessed using Cox proportional hazards modeling, and survival was analyzed using the Kaplan-Meier method.

Results: In all 160 patients, 133 (83.1%) exceeded the Milan criteria. Total tumor volume (TTV) > 275 cm³ and serum alpha-fetoprotein (AFP) level > 20 ng/mL were associated with disease-free survival. Patients beyond the Milan criteria were grouped into three risk categories: no risk (TTV ≤ 275 cm³ and AFP ≤ 20 ng/mL, n = 39), one risk (either TTV > 275 cm³ or AFP > 20 ng/mL, n = 76), and two risks (TTV > 275 cm³ and AFP > 20 ng/mL, n = 18). No-risk group had comparable disease-free survival (p = 0.269) and overall survival (p = 0.215) to patients who met the Milan criteria.

Conclusion: Patients with TTV ≤ 275 cm³ and AFP ≤ 20 ng/mL can have good outcomes even exceed the Milan criteria.

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基于肿瘤总体积的肝细胞癌和多发性肿瘤患者肝脏切除标准。

背景：在许多亚洲肝细胞癌（HCC）指南中，切除是多发性 HCC 的一种选择。根据传统的肿瘤负荷定义，很难比较小肿瘤但多发肿瘤与较少的大肿瘤。我们旨在评估肝切除术对多发性 HCC 的作用，并确定与生存获益相关的因素：我们回顾了 2003 年 7 月至 2018 年 12 月间接受肝切除术的 160 例多发性 HCC 患者。采用 Cox 比例危险模型评估肿瘤复发的风险因素，并采用 Kaplan-Meier 法分析生存率：在所有160名患者中，133人（83.1%）超过了米兰标准。肿瘤总体积（TTV）大于275立方厘米和血清甲胎蛋白（AFP）水平大于20纳克/毫升与无病生存率有关。超过米兰标准的患者被分为三种风险类别：无风险（TTV ≤ 275 cm3 和 AFP ≤ 20 ng/mL，n = 39）、一种风险（TTV > 275 cm3 或 AFP > 20 ng/mL，n = 76）和两种风险（TTV > 275 cm3 和 AFP > 20 ng/mL，n = 18）。无风险组的无病生存期（P = 0.269）和总生存期（P = 0.215）与符合米兰标准的患者相当：结论：TTV ≤ 275 cm3 和 AFP ≤ 20 ng/mL 的患者即使超过米兰标准，也能获得良好的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Diseases and Sciences 医学-胃肠肝病学

CiteScore

6.40

自引率

3.20%

发文量

420

审稿时长

1 months

期刊介绍： Digestive Diseases and Sciences publishes high-quality, peer-reviewed, original papers addressing aspects of basic/translational and clinical research in gastroenterology, hepatology, and related fields. This well-illustrated journal features comprehensive coverage of basic pathophysiology, new technological advances, and clinical breakthroughs; insights from prominent academicians and practitioners concerning new scientific developments and practical medical issues; and discussions focusing on the latest changes in local and worldwide social, economic, and governmental policies that affect the delivery of care within the disciplines of gastroenterology and hepatology.

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