Ann Surg：肝细胞癌TNM分期似应考虑肿瘤破裂因素

在2013年3月8日出版的《外科学年鉴》(Annals of Surgery)杂志上，发表了日本东京大学Norihiro Kokudo博士等人的一项研究结果，该研究通过一个大型患者队列，对肝细胞癌(HCC)破裂的背景特征进行了考察，并阐明了肿瘤破裂对患者预后的真正影响。HCC瘤体自发性破裂与极差的患者预后有关，现行TNM分期系统根据尚不充分的证据，将HCC破裂划分为T4期。

2000年至2005年期间，在日本进行了一项全国性调查结果，该研究通过这项调查结果相关数据库，共筛选出1106例HCC破裂患者。研究人员通过单变量及多变量逻辑回归模型，对破裂HCC相关的临床病理学参数进行了考察。并对得到的破裂及非破裂HCC相关生存曲线进行了对比，以评价(破裂)事件本身对患者预后及TNM分期系统的影响。

多变量分析结果表明，肿瘤破裂与较差的肝储备功能以及较晚的肿瘤状态有关。根据TNM分期基线对生存率曲线进行分层后的分析显示，肿瘤破裂因素对未发生破裂的基线生存率曲线产生附加影响，可对基线肿瘤分期产生0.5至2个等级的影响。

该研究表明，肿瘤破裂事件本身即对患者生存产生不利影响。然而，其影响并不能抵消其他肿瘤相关参数所带来的影响。因此，在HCC肿瘤破裂的情况下，似宜对肿瘤分期基线添加附加分期。

与肝细胞癌相关的拓展阅读：

• 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
• 肝细胞癌诊断与治疗路线图（修订版）
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Prognostic Impact of Spontaneous Tumor Rupture in Patients With Hepatocellular Carcinoma: An Analysis of 1160 Cases From a Nationwide Survey.
OBJECTIVE
The aim of the present study was to investigate the background characteriscs of ruptured hepatocellular carcinoma (HCC) and to clarify the true impact of tumor rupture on patient prognosis in a large patient cohort. BACKGROUND:: Spontaneous tumor rupture of HCC has been associated with a very poor patient prognosis and the current TNM staging systems classify ruptured HCC as T4 based on insufficient evidence.
METHODS
In total, 1106 patients with ruptured HCC were extracted from the database of a nationwide survey conducted in Japan from 2000 to 2005. The clinicopathological parameters associated with HCC rupture were investigated using univariate and multivariate logistic regression models. The survival curves for ruptured and nonruptured HCC were generated and compared to evaluate the impact of the event (rupture) itself on patient prognosis and the TNM staging systems.
RESULTS
The multivariate analyses showed that tumor rupture was associated with both a poor liver functional reserve and an advanced tumor status. Analyses of the survival curves stratified according to the baseline TNM staging showed that tumor rupture had an additional impact on the baseline survival curves without rupture, and the impact corresponded to the addition of 0.5 to 2 stages to the baseline tumor staging.
CONCLUSIONS
The present study suggested that tumor rupture itself had a negative impact on patient survival. However, its impact was not strong enough to cancel the effects of the other tumor-related parameters. Therefore, it may be appropriate to give additional stages to the baseline tumor staging in cases of ruptured HCC.