Value of postoperative radiotherapy for centrally located hepatocellular carcinoma
Wang Zhi*, Wang Weihu, Zhang Tao, Jin Jing, Wang Shulian, Song Yongwen, Liu Yueping, Ren Hua, Fang Hui, Wang Wenqing, Wu Jianxiong, Rong Weiqi, Wang Liming, Liu Xinfan, Yu Zihao, Li Yexiong
*Department of Radiation Oncology,Cancer Hospital,Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021,China
Abstract：Objective To assess the effects of postoperative radiotherapy on the prognosis and recurrent patterns of centrally located hepatocellular carcinoma (HCC). Methods From July 2007 to December 2011, 116 patients with centrally located HCC (resection margin<1 cm) were treated by surgery, and 33 of them received postoperative radiotherapy. The prognosis and recurrent patterns were compared between the postoperative radiotherapy (PORT) group and surgery alone (SA) group. The Kaplan-Meier method was used to calculate disease-free survival (DFS) and overall survival (OS);the log-rank test was used for univariate analysis, and the Cox regression model was used for multivariate prognostic analysis. Results The 1-, 3-, and 5-year sample sizes were 104,89 and 83, respectively. The 1-, 3-, and 5-year DFS rates for PORT group were 82%, 64%, and 49%, respectively, versus 63%, 52%, and 22% for SA group (P=0.038);the 1-, 3-, and 5-year OS rates for PORT group were 97%, 89%, and 68%, respectively, versus 87%, 68%, and 46% for SA group (P=0.009). The numbers of patients with surgical margin recurrence, single recurrence beyond the margin, and diffuse recurrence in PORT group were 0, 11, and 2, respectively, versus 8, 11, and 18 in SA group (P=0.011);the numbers of patients with early recurrence (within 18 months after surgery) and late recurrence (at least 18 months after surgery) inPORT group were 6 and 7, respectively, versus 36 and 7 in SA group (P=0.016). ConclusionsPostoperative radiotherapy is safe and can significantly improve prognosis in patients with centrally located HCC.
[1] 何生.特殊部位的肝切除术[J].四川医学,2002,23:425-427. [2] Mehrabi A, Mood ZA, Roshanaei N, et al. Mesohepatectomy as an option for the treatment of central liver tumors[J]. J Am Coll Surg,2008,207:499-509. [3] Cheng CH, Yu MC, Wu TH, et al. Surgical resection of centrally located large hepatocellular carcinoma[J]. Chang Gung Med J,2012,35:178-191. [4] 吴健雄,王黎明,刘立国,等.肝区域血流选择性适时阻断在肝中央型大肿瘤切除中的应用[J].中华肿瘤杂志,2012,34:850-854. [5] Shi M, Zhang CQ, Zhang YQ, et al. Micrometastases of solitary hepatocellular carcinoma and appropriate resection margin[J]. World J Surg,2004,28:376-381. [6] Belghiti J, Panis Y, Farges O, et al. Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis[J]. Ann Surg,1991,214:114-117. [7] Jeng KS, Jeng WJ, Sheen IS, et al. Is less than 5 mm as the narrowest surgical margin width in central resections of hepatocellular carcinoma justified[J]? Am J Surg,2013,206:64-71. [8] Huang ZY, Liang BY, Xiong M, et al. Long-term outcomes of repeat hepatic resection in patients with recurrent hepatocellular carcinoma and analysis of recurrent types and their prognosis:a single-center experience in China[J]. Ann Surg Oncol,2012,19:2515-2525. [9] Cucchetti A, Piscaglia F, Caturelli E, et al. Comparison of recurrence of hepatocellular carcinoma after resection in patients with cirrhosis to its occurrence in a surveilled cirrhotic population[J]. Ann Surg Oncol,2009,16:413-422. [10] Poon RT, Fan ST, Ng IO, et al, Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma[J]. Cancer,2000,89:500-507. [11] Matsui Y, Terakawa N, Satoi S, et al. Postoperative outcomes in patients with hepatocellular carcinomas resected with exposure of the tumor surface, clinical role of the no-margin resection[J]. Arch Surg,2007,142:596-602. [12] Lee KT, Wang SN, Su RW, et al. Is wider surgical margin justified for better clinical outcomes in patients with resectable hepatocellular carcinoma[J]? J Formos Med Assoc,2012,111:160-170. [13] Shi M, Guo RP, Lin XJ, et al. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma:a prospective randomized trial[J]. Ann Surg,2007,245:36-43. [14] Salloum C, Castaing D. Surgical margin status in hepatectomy for liver tumors[J]. Bull Cancer,2008,95:1183-1191. [15] Tralho JG, Kayal S, Dagher I, et al. Resection of hepatocellular carcinoma:the effect of surgical margin and blood transfusion on long-term survival. Analysis of 209 consecutive patients[J]. Hepatogastroenterology,2007,54:1200-1206. [16] Chau GY, Lui WY, Tsay SH, et al. Prognostic significance of surgical margin in hepatocellular carcinoma resection:an analysis of 165 Childs′ A patients[J]. J Surg Oncol,1997,66:122-126. [17] Zeng ZC, Jiang GL, Wang GM,et al. DNA-PKes subunits in radiosensitization by hyperthermia on hepatocellular carcinoma HepG2 cell line[J]. World J Gastroenterol,2002,8:797-803. [18] Jiang W, Zeng ZC. Is it time to adopt external beam radiotherapy in the NCCN guidelines as a therapeutic strategy for intermediate/advanced hepatocellular carcinoma[J]? Oncology,2013,84 Suppl :69-74. [19] Matsumata T,Kanematsu T,Takenaka K,et al. Patterns of intrahepatic recurrence after curative resection of hepatocellular carcinoma[J]. Hepatology,1989,9:457-460. [20] Poon RT, Fan ST, Ng IO, et al. Significance of resection margin in hepatectomy for hepatocellular carcinoma. a critical reappraisal[J]. Ann Surg,2000,231:544-551. [21] Lee HY, Rhim H, Lee MW, et al. Early diffuse recurrence of hepatocellular carcinoma after percutaneous radiofrequency ablation:analysis of risk factors[J]. Eur Radiol,2013,23:190-197. [22] Kim BW, Kim YB, Wang HJ, et al. Risk factors for immediate post-operative fatal recurrence after curative resection of hepatocellular carcinoma[J]. World J Gastroenterol,2006,12:99-104.
2014, Vol. 23 
