Hepatic Resection for “BCLC Stage A-Hepatocellular Carcinoma. The Prognostic Role of Alpha-Fetoprotein

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• 作者：Roberto Santambrogio MD (1)
  Enrico Opocher MD (1)
  Mara Costa MD (1)
  Matteo Barabino MD (1)
  Massimo Zuin MD (2)
  Emanuela Bertolini MD (2)
  Francesca De Filippi MD (3)
  Savino Bruno MD (3)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2012
• 出版时间：February 2012
• 年：2012
• 卷：19
• 期：2
• 页码：426-434
• 全文大小：609KB
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• 作者单位：Roberto Santambrogio MD (1)
  Enrico Opocher MD (1)
  Mara Costa MD (1)
  Matteo Barabino MD (1)
  Massimo Zuin MD (2)
  Emanuela Bertolini MD (2)
  Francesca De Filippi MD (3)
  Savino Bruno MD (3)
  
  1. UOC di Chirurgia 2 (Chirurgia Epato-bilio-pancreatica e Digestiva), A.O. San Paolo, Dipartimento di Medicina, Chirurgia ed Odontoiatria, Università degli Studi di Milano, Milan, Italy
  2. Divisione di Medicina Interna-Epatologia, A.O. San Paolo, Dipartimento di Medicina, Chirurgia ed Odontoiatria, Università degli Studi di Milano, Milan, Italy
  3. UOC di Medicina Interna ed Epatologia, A.O. Fatebenefratelli ed Oftalmico, Milan, Italy
  

文摘

Background Our aim was to assess the capability of Barcelona Clinic Liver Cancer (BCLC) staging system in allocating stage A patients to hepatic resection (HR) and the effect on survival. Methods We enrolled 132 patients with hepatocellular carcinoma (HCC) amenable to HR. All patients underwent ultrasound (US)-guided anatomical resection (? segments) and then postoperative results were evaluated. Results Results showed 95% of patients were Child A, 49% in BCLC A1, 21% in A2, 6% in A3, and 24% in A4. No 30-day mortality occurred. Overall survival got worse from A1 to A4 (P?=?0.0271), while no differences were found in Childs A patients with or without portal hypertension (P?=?0.1674). Multivariate analysis (Cox model) shows that only AFP (<20?ng/ml) was an independent predictor of survival: If the AFP is incorporated in BCLC staging system (all A1 and A2 patients with abnormal AFP levels were included in A3 subgroup), 5-year survival rate including normal AFP for A1 was 57% and for A2 was 65%, whereas the survival rates impaired in the worst candidates (5-year survival rate including AFP abnormal for A3 and A4 was 36%; P?=?0.002). So, introducing AFP in BCLC classification it is possible to simplify the algorithm in only 2 classes, well-separated in survival curves (class 1 [AFP?]: 60%; class 2 [AFP+]: 37%; P?=?0.0001). Conclusion Our experience stressed the high value of BCLC system in staging of patients with HCC, but underlined that in selected patients (normal AFP) even A2 group may benefit from HR with a good survival.