Ann Surg：淋巴结呈阳性的肝细胞癌患者预后与局部晚期患者类似

尽管存在淋巴结转移的HCC类型被视为一种系统性疾病，但接受淋巴结切除术治疗的患者预后情况尚不明确。为此，日本东京大学医学院的Norihiro Kokudo博士等人进行了一项研究，该研究针对出现淋巴结转移的肝细胞癌(HCC)患者，旨在阐释出淋巴结切除术的临床意义。这项研究结果发表在2013年3月25日在线出版的《外科学年鉴》(Annals of Surgery)杂志上。
根据在日本全国进行的一项调查相关数据库，在2000年至2005年期间，该研究共招募了14,872例接受手术切除治疗的HCC患者。根据是否存在经病理学确认的淋巴结转移情况，研究人员对现行的日本HCC分期系统进行了改进，将IVA期进一步细分为IVA非n1期及IVA n1期。因此，参试患者被划分为6个分期级别，即I期(n = 1494)，II期(n = 8056)， III期 (n = 4243)， IVA非n1期(n = 701)，n1期 (n = 112)以及IVB期 (n = 266)，研究人员对这些患者的长期结局进行了比较。
研究中位随访时间为20.6个月。研究结果表明，IVA非n1期、n1期及IVB期患者的3年总生存率分别为51.6%、38.9%及27.2%。多变量分析表明，IVA非n1期对生存率的影响与n1期相似(h风险比: 0.88, 95% 置信区间: 0.59-1.33, P = 0.555)，n1期仍然是比IVB期更早的一个分期阶段(风险比: 0.52, 95%置信区间: 0.34-0.80, P = 0.003)。
研究人员最后认为，对于经组织学确认，淋巴结呈阳性的HCC患者，其预后情况与局部晚期的HCC (IVA期)患者相似，该结论证实了现行日本分期系统的有效性，同时也部分证实了国际抗癌联盟和美国抗癌联合会(UICC/AJCC)推荐的分期系统。
与肝细胞癌相关的拓展阅读：

• Ann Surg：肝细胞癌TNM分期似应考虑肿瘤破裂因素
• JCO：他汀类药物可降低丙肝人群的肝细胞癌发病风险
• CA Cancer J Clin：肝细胞癌诊疗的最新进展
• Lancet Oncol：晚期肝细胞癌二线治疗新药tivantinib
• 脂肪肝增加肝细胞癌风险
• Oncology：联合mRECIST和AFP比率有助评估肝细胞癌患者预后 更多信息请点击：有关肝细胞癌更多资讯

Impact of Histologically Confirmed Lymph Node Metastases on Patient Survival After Surgical Resection for Hepatocellular Carcinoma: Report of a Japanese Nationwide Survey.
OBJECTIVE
To clarify the clinical significance of resection of lymph node metastases in patients' hepatocellular carcinoma (HCC). BACKGROUND:: Although the presence of lymph node metastasis form HCC has been considered as a systemic disease, prognosis after resection of them remains unknown.
METHODS
From the database of a Japanese nationwide survey, 14,872 patients of HCC treated by surgical resection between 2000 and 2005 were enrolled. We modified the current Japanese staging system for HCC, by further dividing stage IVA into stage IVAnon-n1 and stage n1, according to the absence or presence of pathologically proven lymph node metastasis. Thus, the patients classified into 6 disease stages, that is, I (n = 1494), II (n = 8056), III (n = 4243), IVAnon-n1 (n = 701), n1 (n = 112), and IVB (n = 266), and their long-term outcomes were compared.
RESULTS
The median follow-up period was 20.6 months. The 3-year overall survival rates of the patients with stage IVAnon-n1, stage n1, and stage IVB were 51.6%, 38.9% and 27.2%, respectively. A multivariate analysis showed that stage IVAnon-n1 would have a similar impact on the survival as stage n1 (hazard ratio: 0.88, 95% confidence interval: 0.59-1.33, P = 0.555), and that stage n1 still represented one class less advanced than stage IVB (hazard ratio: 0.52, 95% confidence interval: 0.34-0.80, P = 0.003).
CONCLUSIONS
The prognosis of patients with histologically node-positive HCC was similar to that of patients with locally advanced HCC (stage IVA), which supports the validity of the current Japanese staging system and also partially validates the system proposed by the UICC/AJCC.