微血管侵犯在复发性肝细胞癌中的临床价值
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摘要
目的探讨微血管侵犯(MVI)在肝细胞癌(HCC)根治性切除术后复发患者中的临床价值,为复发患者的随访与治疗提供参考。方法收集2007年1月至2008年12月在复旦大学附属中山医院行根治性切除、且于术后5年内复发的661例HCC患者的临床资料,分析相关的临床病理因素,研究MVI对总体生存率及无瘤生存时间的影响。结果在纳入本研究的HCC复发患者中,MVI总的发生率为31.6%。MVI与患者首次切除术前AFP(P=0.013)水平、肿瘤分化程度(P<0.001)、肿瘤包膜(P<0.001)、肿瘤大小(P<0.001)及BCLC分级(P=0.025)相关;同时,MVI与复发患者是否再次手术切除显著相关(P=0.003)。MVI阳性组和阴性组复发患者切除术后1、3、5年总体生存率分别为68.7%、28.9%、13.7%和77.0%、43.7%、20.3%,中位生存时间分别为22.3个月和30.5个月(P<0.001)。MVI阳性组和阴性组术后1、3、5年无瘤生存率分别为38.8%、7.2%、0和49.3%、16.4%、0,中位无瘤生存时间分别为8个月和11.6个月(P<0.001)。复发后未再次手术切除的患者中,MVI阳性组和阴性组1、3、5年总体生存率分别为63.7%、22.2%、8.9%和70.4%、33.1%、18.2%,中位生存时间分别为20.0个月和25.3个月,两组间整体差异有统计学意义(P=0.014)。而在复发后再切除的患者中,MVI阳性组和阴性组1、3、5年总体生存率分别为96.8%、66.7%、41.5%和96.4%、74.9%、56%,中位生存时间分别为42.6个月和48.6个月,两组无统计学差异(P=0.248)。结论与MVI阴性的复发患者相比,MVI阳性的患者复发时间短,总体生存率差,且再次接受手术的机会较少。但对能够接受再次手术治疗的MVI阳性患者,可以获得与阴性患者相似的生存率,手术在复发患者中仍具有较大治疗价值。
Objective To investigate the clinical values of microvascular invasion(MVI) for recurrent hepatocellular carcinoma(HCC) patients after radical hepatic resections. Methods The clinicopathological data of 661 patients with HCC who underwent R0 resection and recurred within 5 years for the first time at Zhongshan Hospital between Jan. 2007 and Dec. 2008 were collected. Correlations of MVI with clinical demographics were evaluated. The infl uence of MVI on survival and recurrence was also evaluated. Results The incidence of MVI was 31.6% in the study cohort. MVI was correlated with preoperative AFP level(P=0.013), tumor differentiation(P<0.001), tumor capsule(P<0.001), tumor size(P<0.001) and BCLC stage(P=0.025) in the first hepatic resection. MVI was significantly related with the resection rate of recurrent tumor(P=0.003). The 1-, 3-, 5-year overall survival(OS) between MVI positive and negative group were 68.7%, 28.9%, 13.7% and 77.0%, 43.7%, 20.3% respectively, and the median survival time was 22.3 months and 32.5 months(P<0.001). The 1-, 3-, 5-year recurrence free survival(RFS) between MVI positive and negative group were 38.8%, 7.2%, 0 and 49.3%, 16.4%, 0 respectively, the median recurrence free survival time was 8 months and 11.6 months(P<0.001). Among patients who did not receive re-resections, the 1-, 3-, 5-year OS between MVI positive and negative group were 63.7%, 22.2%, 8.9% and 70.4%, 33.1%, 18.2% respectively, and the median survival time was 20.0 months and 25.3 months(P<0.001). However, among patients who received re-resections, the 1-, 3-, 5-year OS between MVI positive and negative group were 96.8%, 66.7%, 41.5% and 96.4%, 74.9%, 56% respectively, and the median survival time was 42.6 months and 48.6 months, which indicated no significance(P=0.248). Conclusion Compare with recurrent HCC patients MVI negative, MVI positive patients show shorter RFS time, poorer OS, and fewer chances of undergoing re-resection. However, similar OS can be obtained if undergoing reresection, surgery is still the most effective treatment for recurrence in those MVI positive recurrent patients.
Objective To investigate the clinical values of microvascular invasion(MVI) for recurrent hepatocellular carcinoma(HCC) patients after radical hepatic resections. Methods The clinicopathological data of 661 patients with HCC who underwent R0 resection and recurred within 5 years for the first time at Zhongshan Hospital between Jan. 2007 and Dec. 2008 were collected. Correlations of MVI with clinical demographics were evaluated. The infl uence of MVI on survival and recurrence was also evaluated. Results The incidence of MVI was 31.6% in the study cohort. MVI was correlated with preoperative AFP level(P=0.013), tumor differentiation(P<0.001), tumor capsule(P<0.001), tumor size(P<0.001) and BCLC stage(P=0.025) in the first hepatic resection. MVI was significantly related with the resection rate of recurrent tumor(P=0.003). The 1-, 3-, 5-year overall survival(OS) between MVI positive and negative group were 68.7%, 28.9%, 13.7% and 77.0%, 43.7%, 20.3% respectively, and the median survival time was 22.3 months and 32.5 months(P<0.001). The 1-, 3-, 5-year recurrence free survival(RFS) between MVI positive and negative group were 38.8%, 7.2%, 0 and 49.3%, 16.4%, 0 respectively, the median recurrence free survival time was 8 months and 11.6 months(P<0.001). Among patients who did not receive re-resections, the 1-, 3-, 5-year OS between MVI positive and negative group were 63.7%, 22.2%, 8.9% and 70.4%, 33.1%, 18.2% respectively, and the median survival time was 20.0 months and 25.3 months(P<0.001). However, among patients who received re-resections, the 1-, 3-, 5-year OS between MVI positive and negative group were 96.8%, 66.7%, 41.5% and 96.4%, 74.9%, 56% respectively, and the median survival time was 42.6 months and 48.6 months, which indicated no significance(P=0.248). Conclusion Compare with recurrent HCC patients MVI negative, MVI positive patients show shorter RFS time, poorer OS, and fewer chances of undergoing re-resection. However, similar OS can be obtained if undergoing reresection, surgery is still the most effective treatment for recurrence in those MVI positive recurrent patients.
引文
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[8]Portolani N,Coniglio A,Ghidoni S,et al.Early and late recurrence after liver resection for hepatocellular carcinoma:prognostic and therapeutic implications[J].Ann Surg,2006,243(2):229-235.
[2]Lim KC,Chow PK,Allen JC,et al.Microvascular invasion is a better predictor of tumor recurrence and overall survival following surgical resection for hepatocellular carcinoma compared to the Milan criteria[J].Ann Surg,2011,254(1):108-113.
[3]刘臻玉,武丹,区锦玲,等.肝癌微血管侵犯的特点及相关临床指标[J].肝胆胰外科杂志,2017,29(2):107-111.
[4]Zhou J,Wang Z,Ren Z,et al.Adjuvant transarterial chemoembolization for HBV-related hepatocellular carcinoma after resection:a randomized controlled study[J].Clin Cancer Res,2018.[Epub ahead of print]
[5]Bruix J,Sherman M,American Association for the Study of Liver Diseases.Management of hepatocellular carcinoma:an update[J].Hepatology,2011,53(3):1020-1022.
[6]Akamatsu N,Cillo U,Cucchetti A,et al.Surgery and Hepatocellular Carcinoma[J].Liver Cancer,2016,6(1):44-50.
[7]董辉,丛文铭.提高肝癌规范化病理诊断水平,为临床精细化治疗保驾护航——《原发性肝癌规范化病理诊断指南(2015年版)》解读[J].中国普通外科杂志,2016,25(7):939-943.
[8]Portolani N,Coniglio A,Ghidoni S,et al.Early and late recurrence after liver resection for hepatocellular carcinoma:prognostic and therapeutic implications[J].Ann Surg,2006,243(2):229-235.