Poon R T, Fan S T, Lo C M, Liu C L, Wong J
Department of Surgery, The University of Hong Kong Medical Centre, Queen Mary Hospital, China.
Ann Surg. 1999 Feb;229(2):216-22. doi: 10.1097/00000658-199902000-00009.
This study aimed to evaluate the long-term results of treatment and prognostic factors in patients with intrahepatic recurrence after curative resection of hepatocellular carcinoma (HCC).
Recent studies have demonstrated the usefulness of re-resection, transarterial oily chemoembolization (TOCE), or percutaneous ethanol injection therapy (PEIT) in selected patients with intrahepatic recurrent HCC. The overall results of a treatment strategy combining these modalities have not been fully evaluated, and the prognostic factors determining survival in these patients remain to be clarified.
Two hundred and forty-four patients who underwent curative resection for HCC were followed for intrahepatic recurrence, which was treated aggressively with a strategy including different modalities. Survival results after recurrence and from initial hepatectomy were analyzed, and prognostic factors were determined by univariate and multivariate analysis using 27 clinicopathologic variables.
One hundred and five patients (43%) with intrahepatic recurrence were treated with re-resection (11), TOCE (71), PEIT (6), systemic chemotherapy (8) or conservatively (9). The overall 1-year, 3-year, and 5-year survival rates from the time of recurrence were 65.5%, 34.9%, and 19.7%, respectively, and from the time of initial hepatectomy were 78.4%, 47.2%, and 30.9%, respectively. The re-resection group had the best survival, followed by the TOCE group. Multivariate analysis revealed Child's B or C grading, serum albumin < or = 40 g/l, multiple recurrent tumors, recurrence < or = 1 year after hepatectomy, and concurrent extrahepatic recurrence to be independent adverse prognostic factors.
Aggressive treatment with a multimodality strategy could result in prolonged survival in patients with intrahepatic recurrence after curative resection for HCC. Prognosis was determined by the liver function status, interval to recurrence, number of recurrent tumors, any concurrent extrahepatic recurrence, and type of treatment.
本研究旨在评估肝细胞癌（HCC）根治性切除术后肝内复发患者的长期治疗结果及预后因素。
近期研究已证明再次切除、经动脉油性化疗栓塞（TOCE）或经皮乙醇注射治疗（PEIT）在部分肝内复发性HCC患者中的有效性。尚未对联合这些治疗方式的治疗策略的总体结果进行全面评估，且决定这些患者生存的预后因素仍有待阐明。
对244例行HCC根治性切除的患者进行肝内复发随访，采用包括不同治疗方式的策略积极治疗。分析复发后及初次肝切除后的生存结果，并使用27个临床病理变量通过单因素和多因素分析确定预后因素。
105例（43%）肝内复发患者接受了再次切除（11例）、TOCE（71例）、PEIT（6例）、全身化疗（8例）或保守治疗（9例）。复发后1年、3年和5年的总体生存率分别为65.5%、34.9%和19.7%，初次肝切除后分别为78.4%、47.2%和30.9%。再次切除组的生存率最佳，其次是TOCE组。多因素分析显示Child's B或C级、血清白蛋白≤40 g/l、多发复发肿瘤、肝切除后复发≤1年以及同时存在肝外复发是独立的不良预后因素。
采用多模式策略积极治疗可使HCC根治性切除术后肝内复发患者的生存期延长。预后由肝功能状态、复发间隔、复发肿瘤数量、是否同时存在肝外复发以及治疗类型决定。
