The Recurrence Pattern of Hepatocellular Carcinoma After Resection in Patients with Positive or Close Margin Revealed in Pathological Examinations

肝癌術後病理標本邊緣有腫瘤細胞或接近腫瘤細胞的復發型態

劉千如(Chien-Ru Liu) ； 翁詩涵(Shih-Han Weng) ； 洪文欣(Wen-Hsin Hung) ； 呂志得(Jyh-Der Leu) ； 林志陵(Chih-Lin Lin)

《北市醫學雜誌》 19卷1期 (2022/03) Pp. 69-81

https://doi.org/10.6200/TCMJ.202203_19(1).0007

摘要

Objective: This study aimed to investigate the recurrent patterns and risk factors of patients with hepatocellular carcinoma (HCC) who had undergone surgical liver resection and showed positive or close margin of tumor cells in pathology examinations. The effects of postoperative adjuvant treatment on recurrence were also assessed. Methods: The baseline clinical characteristics and pathological features of HCC patients receiving surgical resection with positive or close (≤1mm) surgical margin were retrospectively enrolled from November 2012 to February 2019. Effects of preoperative clinical values and postoperative tumor cell characteristics on recurrence and survival were analyzed. Results: A total of 50 patients were included in this study. The median follow-up duration was 44 months. The overall recurrence rate was 36 % (18/50). The cumulative disease-free recurrence-free survival was 79.4%, 66.4%, 51.8% at 1, 3, and 5 years, respectively. Among the 18 recurrent patients, 27.8% and 72.2% had surgical margin recurrence and de novo recurrence, respectively. The Cox regression analysis revealed that preoperative α-fetoprotein ＞ 20 ng/ml [hazard ratio (HR):6.37, 95% confidence interval (CI):1.62-25.03, P=0.008] and the presence of satellite nodules (HR:3.6, 95% CI:1.13-11.46, P=0.031) were the recurrent risk factors. Among the eight patients receiving adjuvant radiotherapy, no patient had local recurrence at the surgical margins. Conclusions: De novo recurrent HCC was the primary recurrence pattern of postoperative HCC with positive or close surgical margin. Postoperative adjuvant radiotherapy has the potential to reduce surgical margin recurrence.

關鍵字

Adjuvant radiotherapy ； hepatocellular carcinoma ； recurrence ； surgical margin

並列摘要

目的：針對肝癌術後病理標本邊緣有腫瘤細胞或接近腫瘤細胞的病人，分析其復發型態及與復發相關之危險因子，並評估術後輔助性放射治療的效果。方法：回溯性收集2012年11月至2019年2月，肝癌術後病理標本邊緣有腫瘤細胞或距離腫瘤細胞≤ 1mm的病人，分析術前臨床數值與術後腫瘤細胞病理特徵，對復發或存活的影響。結果：本研究共收集50位病人，平均追蹤時間44個月，整體復發率36%。第1、3、5年的無疾病存活率為79.4%、66.4%、51.8%。在18位復發的病人中，在手術邊緣復發與肝臟內其他部位復發分別為27.8%、72.2%。分析結果顯示術前甲型胎兒蛋白（AFP）＞20 ng/ml與病理有衛星結節表現是復發的危險因子。8位接受術後輔助性放射治療的病人在手術邊緣均無復發。結論：肝癌術後病理標本邊緣有腫瘤細胞或接近腫瘤細胞的病人，主要復發型態是在肝臟內其他部位復發。術後輔助性放射治療有可能降低手術邊緣局部復發的機率。

並列關鍵字

輔助性放射治療 ； 肝癌 ； 復發 ； 手術邊緣