Na Reum Kim, Gi Hong Choi, Dai Hoon Han, Kyung Sik Kim, Jin Sub Choi
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引用次数: 0
Abstract
Purpose: Advanced techniques and multidisciplinary approaches have improved hepatocellular carcinoma (HCC) surgical outcomes. This study updates the long-term survival after liver resection (LR) for HCC based on over 20 years of experience.
Materials and methods: Between 1996 and 2017, 1963 patients with HCC underwent LR. After excluding 185 patients who received preoperative therapy, 1778 treatment-naïve HCC patients were included. Clinicopathological characteristics and surgical outcomes were compared across three periods: 1 (1996-2007), 2 (2008-2012), and 3 (2013-2017). Prognostic factors for overall survival (OS) and disease-free survival (DFS) were analyzed using Cox regression analysis.
Results: Recent trends indicate increased diagnoses at older ages, number of non-B and non-C HCC cases and decreased incidence of cirrhosis. Minor, non-anatomical, and minimally invasive LR have become more prevalent. In period 3, short-term outcomes improved, as 90-day mortality decreased to 0.3% and major complications to 5.0%. Long-term outcomes improved (5-year OS: 68.1% vs. 80.7% vs. 90.5%, p<0.001; 5-year DFS: 41.4% vs. 50.7% vs. 61.1%, p<0.001), and early recurrence rates decreased in period 3 (34.0% vs. 34.0% vs. 25.8%, p<0.001). Factors such as smaller tumor size, decreased incidence of cirrhosis, fewer intraoperative transfusions, and fewer major complications have contributed to improved OS and DFS.
Conclusion: Remarkable improvements in 5-year OS and DFS were observed after curative LR for HCC, particularly in period 3. Advancements in surgical outcomes, including very low short-term mortality, along with improved surgical techniques, early detection, and refined patient selection, are likely key factors in this progress.
目的:先进的技术和多学科方法改善了肝细胞癌(HCC)的手术效果。本研究基于20多年的经验更新了肝癌肝切除术后的长期生存率。材料和方法:1996年至2017年,1963例HCC患者行LR。在排除185例接受术前治疗的患者后,纳入1778例treatment-naïve HCC患者。临床病理特征和手术结果在三个时期进行比较:1(1996-2007),2(2008-2012)和3(2013-2017)。采用Cox回归分析总生存期(OS)和无病生存期(DFS)的预后因素。结果:最近的趋势表明,年龄较大的HCC诊断率增加,非b型和非c型HCC病例数量增加,肝硬化发病率下降。轻微的、非解剖性的、微创性的LR变得越来越普遍。在第3期,短期结果得到改善,90天死亡率降至0.3%,主要并发症降至5.0%。长期预后改善(5年OS: 68.1% vs. 80.7% vs. 90.5%, ppp)结论:HCC根治性LR治疗后5年OS和DFS显著改善,特别是在第3期。手术结果的进步,包括极低的短期死亡率,以及手术技术的改进,早期发现和精确的患者选择,可能是这一进展的关键因素。
期刊介绍:
The goal of the Yonsei Medical Journal (YMJ) is to publish high quality manuscripts dedicated to clinical or basic research. Any authors affiliated with an accredited biomedical institution may submit manuscripts of original articles, review articles, case reports, brief communications, and letters to the Editor.