J CANCER RES CLIN：部分进展期肝癌仍可手术
2012-11-29 J CANCER RES CLIN J CANCER RES CLIN
上海第二军医大学东方肝胆外科医院杨田等近期发表的一项回顾性分析表明，根据国际认可的巴塞罗那分期（BCLC）判断为进展期（C 期）的肝细胞癌患者，在肿瘤可切除、肝功能储备良好和剩余肝体积足够的情况下，仍可考虑外科手术治疗。 该研究纳入了2001-2007 年收治的511 例判定为BC
上海第二军医大学东方肝胆外科医院杨田等近期发表的一项回顾性分析表明，根据国际认可的巴塞罗那分期（BCLC）判断为进展期（C 期）的肝细胞癌患者，在肿瘤可切除、肝功能储备良好和剩余肝体积足够的情况下，仍可考虑外科手术治疗。
该研究纳入了2001-2007 年收治的511 例判定为BCLC 进展期（合并门静脉浸润，或合并淋巴结或远处转移，或患者体力状态ECOG 分级1~2 级）的肝癌患者，受试者均行肝癌切除术且术后病理证实为肝细胞癌。该组患者的围手术期死亡率为2.3%，并发症总发生率为31.3%。中位随访27.8 个月的结果显示，1年、3 年和5 年总生存率分别69.9%、41.2% 和30.5%，无疾病生存率依次为48.2%、30.3% 和24.0%，这些数据明显优于既往文献报道中采取保守治疗或口服分子靶向药物索拉非尼治疗的同期肝癌患者的数据。研究者发现，伴血管或胆道浸润、肝外转移的患者的总生存率和无疾病生存率均显著降低。
对于BCLC 分期判断为进展期的肝癌患者，一般建议口服分子靶向药物索拉非尼或采取保守治疗，而不建议手术治疗。尽管BCLC 分期在国际上被广泛认可，但该研究表明，根据该分期推荐的治疗策略并不完全适用于所有肝癌患者。因此，临床医生应结合患者的实际情况，具体问题具体分析，采取合理的规范化治疗。研究还提到，今后应在临床上有目的性地开展一些针对进展期肝癌的前瞻性随机对照研究，如手术联合分子靶向药物的综合治疗等。
Surgical resection for advanced hepatocellular carcinoma according to Barcelona Clinic Liver Cancer (BCLC) staging
Purpose
The BCLC staging classification has been widely endorsed to predict the prognosis of patients with HCC. However, its validity as a means of therapeutic instructions needs to be challenged. This study aimed to evaluate perioperative and long-term outcomes of surgical resection in patients with advanced hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer (BCLC) staging.
Methods
This study used a prospectively maintained database consisting of a consecutive series of 511 Chinese patients with advanced HCC who underwent surgical resection in a hepatobiliary surgical center from 2001 to 2007. Mortality, morbidity, long-term overall survival (OS) and disease-free survival (DFS) were evaluated.
Results
Hospital mortality was 2.3%, and overall morbidity was 31.3%. After a median follow-up period of 27.8 months (range, 0–112 months), the 1-, 3- and 5-year OS rate was 69.9, 41.2 and 30.5%, and the 1-, 3- and 5-year DFS rate was 48.2, 30.3 and 24.0%, respectively. The 1-, 3- and 5-year OS and DFS rates were significantly poorer in patients with vascular invasion and/or extrahepatic spread than those in patients without (both P < 0.001), and also poorer in patients with biliary invasion than those in patients without (both P < 0.05).
Conclusions
Surgical resection could be considered in part of patients with advanced HCC (BCLC stage C), with low mortality, acceptable morbidity and favorable survival benefits. These results imply that BCLC recommendations for treatment schedules of advanced HCC need to be re-evaluated.
Surgical resection for advanced hepatocellular carcinoma according to Barcelona Clinic Liver Cancer (BCLC) staging
Purpose
The BCLC staging classification has been widely endorsed to predict the prognosis of patients with HCC. However, its validity as a means of therapeutic instructions needs to be challenged. This study aimed to evaluate perioperative and long-term outcomes of surgical resection in patients with advanced hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer (BCLC) staging.
Methods
This study used a prospectively maintained database consisting of a consecutive series of 511 Chinese patients with advanced HCC who underwent surgical resection in a hepatobiliary surgical center from 2001 to 2007. Mortality, morbidity, long-term overall survival (OS) and disease-free survival (DFS) were evaluated.
Results
Hospital mortality was 2.3%, and overall morbidity was 31.3%. After a median follow-up period of 27.8 months (range, 0–112 months), the 1-, 3- and 5-year OS rate was 69.9, 41.2 and 30.5%, and the 1-, 3- and 5-year DFS rate was 48.2, 30.3 and 24.0%, respectively. The 1-, 3- and 5-year OS and DFS rates were significantly poorer in patients with vascular invasion and/or extrahepatic spread than those in patients without (both P < 0.001), and also poorer in patients with biliary invasion than those in patients without (both P < 0.05).
Conclusions
Surgical resection could be considered in part of patients with advanced HCC (BCLC stage C), with low mortality, acceptable morbidity and favorable survival benefits. These results imply that BCLC recommendations for treatment schedules of advanced HCC need to be re-evaluated.
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#进展期#
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