目的:肝细胞腺瘤(MT-HCA)的恶性转化可能发生在多达5%的肿瘤中。然而,该事件的预后价值仍未得到充分描述.在这项研究中,我们旨在分析接受MT-HCA肝切除术(LR)的患者与正常肝实质(NP-HCC)肝细胞癌(HCC)患者的长期结局.
方法:这项单中心回顾性研究纳入了2001年至2019年在Beaujon医院接受MT-HCALR治疗的所有患者。MT-HCA被分类为恶性转化HCA(SF-HCA)的小病灶,在主要HCC病灶的情况下被分类为恶性HCA(M-HCA)。在倾向评分匹配后,将MT-HCA的无复发生存率(RFS)与NP-HCC的生存率进行比较。
结果:40名患者(24名男性,16名女性)接受了MT-HCA的LR,包括23个SF-HCA和17个M-HCA。在这些案件中,16/40(40%)有β-连环蛋白突变,19/40(47.5%)为炎症,1为HNF1α突变的HCA,4(10%)为未分类的HCA。微血管侵犯(12%vs.0%,p=0.091)和卫星结节(25%与4%,p=0.028)在M-HCA中比在SF-HCA中更常见。经过67个月的中位随访,10例(25%)MT-HCA患者肿瘤复发,其中9例使用M-HCA,1例使用SF-HCA(p=0.007)。M-HCA与明显较差的1-,3-,5年和10年RFS率高于SF-HCA(76%,63%,39%,37%vs.100%,100%,100%,91%,p=0.003)。多因素分析显示SF-HCA与改善的RFS独立相关(风险比0.064;95%CI0.008-0.519;p=0.01)。在倾向得分匹配后,NP-HCC与显著较差的1-,3-,5年和10年RFS率高于MT-HCA(p=0.01)。
结论:HCA伴恶性转化产生比NP-HCC更好的长期预后。在MT-HCA中,SF-HCA比M-HCA具有更好的预后。
背景:肝细胞腺瘤(HCA)恶性转化的预后相关性仍然未知。因此,本研究的目的是比较接受肝切除术的恶性转化患者与接受肝切除术的肝细胞癌(HCC)患者的结局.癌症切除后的主要长期风险是复发。在这项研究中,10/40例HCA恶变患者切除后复发,我们确定年龄>55岁,卫星节点的存在,和微血管侵犯是长期复发的危险因素。与HCC患者相比,因HCA导致恶变而接受肝切除术的患者具有较好的长期生存率.
OBJECTIVE: Malignant transformation of hepatocellular adenoma (MT-HCA) may occur in up to 5% of tumours. However, the prognostic value of this event remains poorly described. In this study, we aimed to analyse the long-term outcomes of patients undergoing liver resection (LR) for MT-HCA compared to those of patients resected for hepatocellular carcinoma (HCC) occurring on normal liver parenchyma (NP-HCC).
METHODS: This single-centre retrospective study included all patients who underwent LR for MT-HCA at Beaujon Hospital between 2001 and 2019. MT-HCAs were classified as small foci of malignant transformation HCA (SF-HCA) and as malignant HCA (M-HCA) in cases of predominant HCC foci. Recurrence-free survival (RFS) of MT-HCA was compared with that of NP-HCC after propensity score matching.
RESULTS: Forty patients (24 men, 16 women) underwent LR for MT-HCA, including 23 with SF-HCA and 17 with M-HCA. Of these cases, 16/40 (40%) had β-catenin mutations, 19/40 (47.5%) were inflammatory, 1 was HNF1α-mutated HCA and 4 (10%) were unclassified HCA. Microvascular invasion (12% vs. 0%, p = 0.091) and satellite nodules (25% vs. 4%, p = 0.028) were more frequently observed in M-HCA than in SF-HCA. After a median follow-up of 67 months, 10 (25%) patients with MT-HCA had tumour recurrence, including 9 with M-HCA and 1 with SF-HCA (p = 0.007). M-HCA was linked to significantly poorer 1-, 3-, 5- and 10-year RFS rates than SF-HCA (76%, 63%, 39%, 37% vs. 100%, 100%, 100%, 91%, p = 0.003). Multivariate analysis showed that SF-HCA was independently associated with improved RFS (hazard ratio 0.064; 95% CI 0.008-0.519; p = 0.01). After propensity score matching, NP-HCC was associated with significantly poorer 1-, 3-, 5- and 10-year RFS rates than MT-HCA (p = 0.01).
CONCLUSIONS: HCA with malignant transformation yields a better long-term prognosis than NP-HCC. Among MT-HCA, SF-HCA is associated with a better prognosis than M-HCA.
BACKGROUND: The prognostic relevance of malignant transformation of hepatocellular adenoma (HCA) remains unknown. Thus, the aim of our study was to compare the outcomes of patients undergoing liver resection for malignant transformation to those of patients undergoing liver resection for hepatocellular carcinoma (HCC). The main long-term risk after resection for carcinoma is recurrence. In this study, 10/40 patients with malignant transformation of HCA relapsed after resection and we identified age >55 years, presence of satellite nodes, and microvascular invasion as risk factors for long-term recurrence. Compared to patients with HCC, patients who underwent liver resection for HCA with malignant transformation had better long-term survival.