Sakon M, Umeshita K, Nagano H, Eguchi H, Kishimoto S, Miyamoto A, Ohshima S, Dono K, Nakamori S, Gotoh M, Monden M
Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan.
Arch Surg. 2000 Dec;135(12):1456-9. doi: 10.1001/archsurg.135.12.1456.
The clinical significance of hepatectomy for hepatocellular carcinoma (HCC) is still controversial because of frequent intrahepatic recurrence, which results from either recurrence due to residual intrahepatic metastasis (Rim) or recurrence due to metachronous, multicentric liver carcinogenesis (Rmc).
Retrospective review. Disease-free survival curves were obtained by the Kaplan-Meier method and the rates of Rim and Rmc were analyzed using 2 regression lines, based on the evidence that Rmc occurs at a constant rate throughout follow-up, whereas Rim occurs only in the early postoperative period.
University hospital.
From 1980 to 1996, 241 patients with HCC who underwent curative hepatic resection.
Intrahepatic recurrence.
Disease-free survival curves for all patients in the early (within 2 years) and late (4 years after surgery) follow-up were approximated by 2 regression lines, which represent both Rim and Rmc (Y(1) = -3.4X + 48) and only Rmc (Y(2) = -23.1X + 98). Using this approximation, the annual incidence of Rim within 2 years (a(1)-a(2)) was calculated as 19.7% and that of Rmc (a(2)) was 3.4%. The ratio of Rim in tumor recurrence (b(1)-b(2)) was 50%, and that of Rmc (b(1)) was 48%. The ratios of Rmc in patients with stages I and II HCC were 60% and 64%, respectively. In contrast, the values could not be calculated in patients with stages III and IVA because all but 2 patients showed recurrence within 4 years after surgery.
Tumor recurrence is estimated to result from metachronous liver carcinogenesis in 48% of hepatectomized patients with HCC.
由于肝内复发频繁，肝癌肝切除术的临床意义仍存在争议，肝内复发是由残留肝内转移（Rim）复发或异时性多中心肝癌发生（Rmc）复发所致。
回顾性研究。采用Kaplan-Meier法绘制无病生存曲线，并基于Rmc在整个随访过程中以恒定速率发生而Rim仅在术后早期发生的证据，使用两条回归线分析Rim和Rmc的发生率。
大学医院。
1980年至1996年期间，241例行根治性肝切除术的肝癌患者。
肝内复发。
所有患者在早期（2年内）和晚期（术后4年）随访的无病生存曲线可由两条回归线近似表示，分别代表Rim和Rmc（Y(1)=-3.4X+48）以及仅Rmc（Y(2)=-23.1X+98）。通过这种近似方法，计算出2年内Rim的年发生率（a(1)-a(2)）为19.7%，Rmc的年发生率（a(2)）为3.4%。肿瘤复发中Rim的比例（b(1)-b(2)）为50%，Rmc的比例（b(1)）为48%。I期和II期肝癌患者中Rmc的比例分别为60%和64%。相比之下，III期和IVA期患者的值无法计算，因为除2例患者外，所有患者均在术后4年内出现复发。
估计48%的肝癌肝切除患者的肿瘤复发是由异时性肝癌发生所致。
