Khuhaprema T
Department of Surgery, National Cancer Institute, Bangkok, Thailand.
J Med Assoc Thai. 1999 Nov;82(11):1071-8.
Hepatocellular carcinoma (HCC) is the most common cancer in Thailand. Hepatic resection has been accepted as the only chance for cure. However; very limited information about the operative treatment and survival of HCC in Thailand has been documented. The author reviewed the experiences of surgical treatment of HCC at the National Cancer Institute, Bangkok and reports herein the long term outcome. From January 1986 to January 1996 a total of 884 primary liver cancers admitted in our institute were reviewed. 112 consecutive hepatic resections were performed by the author. 67 of 112 patients were HCC of which clinical features, survival rate and recurrence were studied. Liver cirrhosis was associated in 49 patients (73.1%). HBsAg was positive in 58 patients (86.6%). Preoperative AFP level was more than 400 ng/ml in 35 patients. The resectability for HCC was 11.0 per cent. In 50 of 67 hepatic resection, major hepatic resection were carried out. Postoperative major complications were found in 14 patients (20.9%). Postoperative mortality rate of 5 patients was 7.5 per cent. Survival curve was calculated by Kaplan-Meier with the overall survival rate at 1, 2, 3, 4, 5 years was 63.2 per cent, 28.6 per cent, 21.1 per cent, 14.5 per cent and 11.5 per cent respectively. 1, 3, 5 years survival rate for a tumor less than 5 cm was 91.0 per cent, 57.0 per cent, 49.4 per cent, tumor size of 5-10 cm was 57.5 per cent, 16.0 per cent, 9.0 per cent and tumor size more than 10 cm was 52.2 per cent, 0 per cent, 0 per cent. A significant difference in survival rate was observed by size. Postoperative recurrences were observed in 45 patients (67.2%) and 82.8 per cent of the patients had intrahepatic recurrence within 2 years. Hepatic resection is an appropriate treatment for a tumor less than 10 cm. However, a tumor larger than 10 cm should be considered for multimodality approaches. Intrahepatic recurrence is high and similar to the reports from the Orient. Close follow-up with prompt treatment for recurrence is the important factor to obtain better results.
肝细胞癌（HCC）是泰国最常见的癌症。肝切除术已被公认为唯一的治愈机会。然而，泰国关于HCC手术治疗和生存情况的资料非常有限。作者回顾了曼谷国家癌症研究所的HCC手术治疗经验，并在此报告长期结果。1986年1月至1996年1月，对我院收治的884例原发性肝癌患者进行了回顾性研究。作者连续进行了112例肝切除术。对其中112例患者中的67例HCC患者的临床特征、生存率和复发情况进行了研究。49例患者（73.1%）伴有肝硬化。58例患者（86.6%）HBsAg呈阳性。35例患者术前甲胎蛋白水平超过400 ng/ml。HCC的可切除率为11.0%。67例肝切除术中，50例进行了大范围肝切除术。14例患者（20.9%）出现术后严重并发症。5例患者术后死亡率为7.5%。采用Kaplan-Meier法计算生存曲线，1年、2年、3年、4年、5年的总生存率分别为63.2%、28.6%、21.1%、14.5%和11.5%。肿瘤小于5 cm者1年、3年、5年生存率分别为91.0%、57.0%、49.4%；肿瘤大小为5 - 10 cm者分别为57.5%、16.0%、9.0%；肿瘤大小超过10 cm者分别为52.2%、0%、0%。不同大小肿瘤的生存率存在显著差异。45例患者（67.2%）出现术后复发，82.8%的患者在2年内出现肝内复发。肝切除术适用于肿瘤小于10 cm的患者。然而，对于肿瘤大于10 cm的患者，应考虑采用多模式治疗方法。肝内复发率较高，与东方国家的报道相似。密切随访并及时治疗复发是获得更好治疗效果的重要因素。
