Nagasue N, Ono T, Yamanoi A, Kohno H, El-Assal O N, Taniura H, Uchida M
Second Department of Surgery, Shimane Medical University, Izumo 693-8501, Japan.
Br J Surg. 2001 Apr;88(4):515-22. doi: 10.1046/j.1365-2168.2001.01732.x.
Detailed follow-up of patients with chronic hepatitis has resulted in increased diagnosis of hepatocellular carcinoma (HCC) in patients without cirrhosis. Despite numerous studies on hepatic resection, the prognostic factors for intrahepatic recurrence and survival are not well known for patients with HCC without cirrhosis.
Among 349 patients with HCC treated in the past 13 years, cirrhosis was absent in 126 patients (36 per cent). Curative hepatic resection was carried out in 100 (79 per cent) of these patients. Risk factors for intrahepatic recurrence and prognostic factors for survival were evaluated by univariate and multivariate analyses.
Postoperative morbidity and mortality rates were 22 and 3 per cent respectively. The 5- and 10-year disease-free and overall survival rates were 31 and 50 per cent, and 22 and 47 per cent respectively. Blood loss, surgical resection margin, intrahepatic metastasis, portal vein invasion and extent of hepatic resection were independently associated with overall survival. However, the only risk factors for intrahepatic recurrence were portal vein invasion and hepatitis C virus (HCV) infection. The former was related to early recurrence while the latter was related to later recurrence. The 5-year disease-free survival rate was 58 per cent in patients with hepatitis B virus infection while it was 6 per cent in patients with HCV infection (P < 0.001).
In the treatment of HCC without cirrhosis, major hepatectomy is advocated to prevent early recurrence. Liver transplantation may be required for patients with HCV infection.
对慢性肝炎患者进行详细随访后，未患肝硬化的患者中肝细胞癌（HCC）的诊断率有所提高。尽管对肝切除术进行了大量研究，但对于无肝硬化的HCC患者，肝内复发和生存的预后因素尚不明确。
在过去13年接受治疗的349例HCC患者中，126例（36%）无肝硬化。其中100例（79%）患者接受了根治性肝切除术。通过单因素和多因素分析评估肝内复发的危险因素和生存的预后因素。
术后发病率和死亡率分别为22%和3%。5年和10年无病生存率及总生存率分别为31%和50%，22%和47%。失血量、手术切缘、肝内转移、门静脉侵犯和肝切除范围与总生存独立相关。然而，肝内复发的唯一危险因素是门静脉侵犯和丙型肝炎病毒（HCV）感染。前者与早期复发有关，后者与晚期复发有关。乙型肝炎病毒感染患者的5年无病生存率为58%，而丙型肝炎病毒感染患者为6%（P<0.001）。
在无肝硬化的HCC治疗中，提倡进行大范围肝切除术以预防早期复发。丙型肝炎病毒感染患者可能需要肝移植。
