期刊
MEDICINE
卷 98, 期 23, 页码 -出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MD.0000000000015540
关键词
hepatocellular carcinoma; prognosis; recurrence
The aim of this study was to investigate the features, treatment, and prognosis of early versus late recurrence of centrally located hepatocellular carcinoma (CL-HCC) after mesohepatectomy (MH). Three hundred forty eight patients with CL-HCC undergoing MH were included. Data on clinicopathological characteristics, initial surgical details, timing and sites of tumor recurrence, management after recurrence, and long-term outcomes were analyzed. The optimal cutoff value to differentiate early (71 patients, 64.5%) versus late (39, 35.5%) recurrence was defined as 12 months. Patients with early recurrence (ER) had higher alpha fetoprotein (AFP) level (P<.001), more advanced tumor stage (P=.024), and higher incidence of microvascular invasion (MVI, P=.001). Patients with ER had higher incidence of local tumor recurrence (P=.027) and higher average number of recurrent nodules (P=.016) than patients with LR. Patients after ER showed a better overall survival (from date of diagnosis of recurrence) than after late recurrence (LR). Patients with ER had less chances of curative treatment (14.1% vs 41.0%, P=.004) after tumor recurrence than patients with LR. Multivariable analyses revealed that liver cirrhosis (P<.001) and tumor differentiation (P<.001) were associated with an increased likelihood of LR, while multiple tumor number (P=.005), type IV classification (P=.012), and MVI (P<.001) were independent risk factors related to ER. ER and LR after MH for CL-HCC were associated with different risk predictors and prognosis. Data on the timing of recurrence may inform decisions about postoperative adjuvant treatment, as well as help to predict long-term survival for these patients.
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