| Abstract | Hepatocelularni karcinom (HCC) je kompleksan zdravstveni problem. Cilj ove studije bila je analiza čimbenika i prognoze preživljenja u cirotičnih bolesnika nakon resekcije hepatocelularnog karcinoma. Analizirani su preoperativni čimbenici koji bi mogli imati utjecaja na različito preživljenje u reseciranih bolesnika: dob, HCC stadij (ukupna veličina tumora (TTD=zbroj promjera svih tumora); Milanski kriteriji, vaskularna infiltracija, udaljene metastaze), mikrovaskularna invazija, histološka diferencijacija, rubovi resekcije, preoperativna funkcija jetre izražena kroz MELD i ALBI score [(log10 BIlirubin x 0.66) + (ALbumin x - 0.085)], prisutnost i stupanj varikoziteta jednjaka (EV). Pre.ivljenje je bilo analizirano od datuma resekcije jetre do datuma smrti, jetrene transplantacije ili kraja praćenja. Pretraživanjem podataka, identificirano je 38 bolesnika (29 muškaraca i 9 žena, srednje dobi 66,5 (39-82) godina tijekom osmogodišnjeg perioda (2006-2014) u KB Dubrava, prema postavljenoj dijagnozi HCC-a. Srednja vrijednost TTD-a bila je 85 mm (30-240 mm), 6 bolesnika imalo je HCC unutar Milanskih kriterija, a 32 bolesnika (84,2%) imali su alkoholnu bolest jetre. Preoperativna vrijednost MELD scorea bila je 8, a srednja vrijednost ALBI scorea bila je -2,63 (-4,03 do -1,16). U 26 (68,4%) bolesnika, reseciran je 1 ili 2 segmenta jetre, a potpuna evakuacija tumora ("čisti rubovi") postignuta je u 12 (31,6%) bolesnika. 35 tumora je bilo srednje do dobro diferencirano, kod većine (33 (86,8%)) je postojala mikrovaskularna invazija. Tijekom perioda praćenja preminula su 24 pacijenta (najkraće i najdulje vrijeme od operacije do smrti je 0,5 i 62 mj). Procijenjeni medijan preživljenja iznosio je 36 mjeseci. Ukupna veličina tumora i ALBI score pokazali su se kao neovisni prognostički indikatori lošijeg ishoda (HR 1.13 (CI 1.07-1.19) za svakih 5 mm veličine tumora; p<0.001 i HR 3.45 (CI 1.49-8.38) za svaku jedinicu ALBI scorea; p=0.003). Iako je studija napravljena na 38 bolesnika, njezini su rezultati u skladu s rezultatima objavljenim u stručnoj literaturi. |
| Abstract (english) | Hepatocellular carcinoma is a complex health problem. The aim of this study was to analyse survival and prognostic indicators in cirrhotic patients resected for hepatocellular carcinoma (HCC). We analyzed preoperative factors that might have influenced different survival of the resected patients: age, HCC stage (total tumor diameter (TTD=sum od diameters of all tumors); Milan criteria, vascular infiltration, distant metastases), microvascular invasion, histological differentiation, resection margins, preoperative liver function as assesed by MELD and ALBI score [(log10 BIlirubin x 0.66) + (ALbumin x – 0.085)], presence and grade of esophageal varices (EV). Survival was analyzed from the date of liver resection until death, liver transplatation or the end of follow-up. By database search we identified 38 patients (29M, 9F, median age 66,5 (38-82) years) resected over 8-year period (2006-2014) in our hospital due to HCC having sufficient diagnostic work-up to be included in this analysis. Median TTD was 85 (30-240) mm, 6 patients had HCC within Milan criteria and 32 pts (84,2%) had alcoholic liver disease. Preoperative MELD was 8, and median ALBI score -2,63 (-4,03 to -1,16). In 26 (68,4%) pts 1 or 2 liver segments were resected and free margin achieved in 12 (31,6%). On patohistological examination 35 tumors were moderately to well differentiated, majority having microvascular invasion as well (in 33 (86,8%)). During follow-up period 24 patients died (shortest and longest time from surgery to death 0,5 and 62 months respectivelly). Estimated median survival time was 36 months. Total tumor diameter and ALBI score were independent prognostic indicators when adjusted for patients' age (HR 1.13 (CI 1.07-1.19) for each 5 mm: p<0.001 and HR 3.45 (CI 1.49-8.38) for each 1 unit; p=0.003 respectivelly). Estimated median survival time in our cohort of patients resected for HCC was 36 months. Total tumor diameter and ALBI score were independent prognostic indicators for survival when adjusted for patient's age. Although it includes only 38 patients, this study shows almost the same results as other similar studies. |
